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February 20, 2002

Research as a Quality Improvement Activity—Reply

Author Affiliations

Stephen J.LurieMD, PhDIndividualAuthor

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

In Reply: I can only agree with Dr Miles and colleagues when they underline the potential of enrolling patients in (multicenter) studies and of installing a research infrastructure to improve the quality of patient care. As I noted in my article, I only addressed 5 approaches to quality improvement and excluded many others. Important elements of such research usually include the collection of data on actual performance, use of standardized protocols for optimal care, and provision of feedback to physicians. Indeed a combination of such interventions could have a large impact on health care quality. However, systematic reviews on the effect of enrolling patients in research or in longitudinal monitoring are, to my knowledge, scarce, which makes it difficult to make a definitive statement on its value. The other problem is that, at least in many countries, setting up a research infrastructure and multicenter data collection is not (yet) within reach of most hospitals, primary care practices, nursing homes, or mental health institutions, which limits the implementation of such a potentially valuable approach. My conclusion for this approach would be, just as it is for the others presented in my article, that we need more evidence of its value and that we need to integrate it with other approaches.