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To the Editor: In their study on quality improvement organizations (QIOs), Drs Snyder and Anderson¹ conclude that improvement in hospital quality indicators is not attributable to QIO interventions because improvement at "intervention" hospitals was significantly greater than improvement at nonintervention hospitals on only 1 of 15 quality measures. However, 4 problems in the study design made finding significant differences unlikely, even if QIOs had been responsible for a large part of improvement over the past 7 years.

First, there was error in measuring intervention/nonintervention (the independent variable). The QIO program policy maximized local flexibility in achieving change goals, so there was no program effort to standardize the definition of an intervention hospital or to test the reliability of any classification made by the QIO. During the study period, QIOs had some contact with essentially all hospitals and often worked with an individual hospital on one topic but not another. Furthermore, . . . [Full Text of this Article]

Stephen F. Jencks, MD, MPH
stephen.jencks@cms.hhs.gov
Office of Clinical Standards & Quality
Centers for Medicare & Medicaid Services
Baltimore, Md

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