This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Related article  • Related letters  • Similar articles in JAMA  Topic Collections  • Quality of Care  • Evidence-Based Medicine  • Quality of Care, Other  • Statistics and Research Methods  • Emergency Medicine  • Alert me on articles by topic  Social Bookmarking   What's this?

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

To the Editor: I found the Commentary by Dr Berwick¹ to be disappointing. The failure to demonstrate the benefit of some quality-improvement activities in clinical trials has led him to propose that we adopt some other means of testing hypotheses concerning quality-improvement interventions.

It is true that underpowered trials should not be used to either dismiss or accept a new intervention. However, if a properly designed and executed clinical trial showed a lack of effect, the first thought should not be to search for another method that might produce a more desired result.

Individuals championing new techniques, procedures, devices, drugs, or other interventions are often unable to be objective observers. That is the reason for clinical trials. It is reasonable to insist on consistent evidence of benefit before making major investments of resources. Trials should not be rejected because they fail to support a preconceived but unproven notion.

Financial Disclosures: . . . [Full Text of this Article]

John C. LaRosa, MD
jclarosa@downstate.edu
SUNY Downstate Medical Center
Brooklyn, New York

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED ARTICLE

The Science of Improvement
Donald M. Berwick
JAMA. 2008;299(10):1182-1184.
EXTRACT | FULL TEXT  

RELATED LETTERS

The Science of Quality Improvement
Pierre Durieux
JAMA. 2008;300(4):390.
EXTRACT | FULL TEXT  

The Science of Quality Improvement
Eddy Fan and Dale M. Needham
JAMA. 2008;300(4):390-391.
EXTRACT | FULL TEXT  

The Science of Quality Improvement
Leonard Bickman
JAMA. 2008;300(4):391.
EXTRACT | FULL TEXT  

The Science of Quality Improvement—Reply
Donald M. Berwick
JAMA. 2008;300(4):391-392.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

A hospital-randomized controlled trial of a formal quality improvement educational program in rural and small community Texas hospitals: one year results
Filardo et al.
Int J Qual Health Care 2009;21:225-232.
ABSTRACT | FULL TEXT