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February 20, 2002

Research as a Quality Improvement Activity

Author Affiliations

Stephen J.LurieMD, PhDIndividualAuthor

JAMA. 2002;287(7):843-844. doi:10.1001/jama.287.7.839

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 the national ESRD database, and a nationwide improvement effort (Kidney Disease Outcome Quality Initiative) has led to significant, measurable improvement in dialysis outcomes and management of anemia resulting in improved 5-year survival rates.5 Embodied in such combined strategies of randomized clinical trials and longitudinal collaborative clinical improvement projects is the concept that there should be no separation between the daily practice of medicine and clinical quality improvement, breakthrough projects, and the use of the latest translational research in the advancement of quality in medical practice, ie, every patient treated is a patient studied.

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