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October 26, 2005

Quality Improvement Organizations and Hospital Care—Reply

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2005;294(16):2028-2030. doi:10.1001/jama.294.16.2030-a

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.

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