This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Contact me when this article is cited  Related Content  • 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.

In Reply: The letters mostly present a classical view of rigor in evaluation without addressing my central thesis: that the power of any method of evaluation varies with the object of evaluation. RCTs in suitable contexts are unmatched; but in other contexts, using an RCT is like searching for oil with a metal detector. It is not a bad tool, just usually the wrong one for the job when the objects of study involve complex social systems.

Dr Durieux points out interestingly that the same may be sometimes true in studying biological responses. That this may be the case for rapid response teams is suggested by the wide gap between, on one hand, some studies (such as the MERIT trial) and, on the other hand, many systematic local observations, some published reports, and common sense. Criteria recently proposed for publishing reports of improvement work have not yet been widely adopted.¹ . . . [Full Text of this Article]

Donald M. Berwick, MD, MPP
dberwick@ihi.org
Institute for Healthcare Improvement
Cambridge, Massachusetts

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

RELATED LETTERS

The Science of Quality Improvement

JAMA. ;300():390-390.
FULL TEXT  

The Science of Quality Improvement
and
JAMA. ;300():390-391.
FULL TEXT  

The Science of Quality Improvement

JAMA. ;300():391-391.
FULL TEXT  

The Science of Quality Improvement

JAMA. ;300():391-391.
FULL TEXT