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Quality Improvement Organizations and Hospital Care—Reply
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In Reply: Dr Jencks and Dr Bratzler raise concerns about distinctions between participating and nonparticipating hospitals and about potential selection biases. We do not have data to determine whether nonparticipating hospitals were more likely to have their own quality improvement initiatives; it is also possible that hospitals interested in quality improvement were more likely to collaborate with the QIOs. While hospital participation is difficult to define, subject to misclassification, and vulnerable to spillover effects, the study findings are supported by several factors. Hospital participation was assigned separately for each clinical area, and sensitivity analyses varying the definition of hospital participation did not affect the study’s overall conclusions. Also, prior to agreeing to participate, all QIOs were informed that our study required classifying hospitals as participating and nonparticipating.
Drs Sugarman and Baumgardner and Dr Jencks discuss issues around the timing of follow-up, including (1) the data reflect care provided only 17 . . . [Full Text of this Article]
Claire Snyder, PhD
csnyder@jhsph.edu
Gerard Anderson, PhD
Johns Hopkins Bloomberg School of Public Health
Baltimore, Md
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