To the Editor.
—In reporting no apparent difference between declining coronary artery bypass graft (CABG) surgery mortality rate trends in Massachusetts and in New York and northern New England, Dr Ghali and colleagues1 have identified something that could be characterized as embarrassing or, at least, surprising. What makes their conclusions difficult to interpret is the absence of information about what did or did not systematically happen during the periods studied.It is apparent from the titles and content of the article by Ghali et al,1 the accompanying Editorial by Dr Jencks,2 and an earlier Editorial by Berwick3 that these authors have assumed that concerted quality improvement efforts took place during the periods surveilled. That the distinctive improvement efforts of any locale constituted any sort of systematic or stable and sustained intervention for any interim period studied is not apparent after reading the source articles.4,5 How
Huff ED. Have Quality Improvement Efforts Decreased Mortality Rates Following Cardiac Surgery?. JAMA. 1997;277(19):1518-1519. doi:10.1001/jama.1997.03540430030025