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July 23 2008

The Science of Quality Improvement

JAMA. 2008;300(4):390-392. doi:10.1001/jama.300.4.391-a

To the Editor: In his Commentary, Dr Berwick1 identified the widespread use and acceptance of RCTs and in general classic experimental design as “ . . . inadequate tools for studying complex, unstable, nonlinear social change” that reveal “little about mechanisms or about factors that affect generalizability.” More than 20 years ago, the field of program evaluation identified that its major purpose was to examine the theory or conceptual basis of the program.2 Comprehensive evaluations address the theory by carefully defining the components of the program and their relationships, and then examining the implementation of these components and how they mediate outcomes.3