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To the Editor: Dr Grol¹ discussed several strategies to improve the quality of medical care but missed 2 of the most effective strategies to systematically improve clinical outcomes—namely, to enroll patients in clinical trials, and to enroll patients in multicenter collaborative clinical improvement projects using shared databases. For more than 30 years, US pediatricians and pediatric oncologists have enrolled more than 90% of children with leukemia in clinical trials, with 5-year cure rates improving from essentially 0% to almost 80%.² At 6 New England centers, every patient undergoing coronary artery bypass grafting is enrolled in a collaborative improvement project with documented significant improvements in mortality.³ Almost 50% of very low birth weight infants in the United States are now enrolled in multicenter collaborative projects with improved outcomes achieved using both randomized clinical trials and clinical improvement efforts.⁴ Virtually every US patient with end stage renal disease (ESRD) is entered into . . . [Full Text of this Article]

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Improving the Quality of Medical Care: Building Bridges Among Professional Pride, Payer Profit, and Patient Satisfaction
Richard Grol
JAMA. 2001;286(20):2578-2585.
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