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September 17, 2003

Early Diagnosis of Sarcoidosis

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;290(11):1454-1455. doi:10.1001/jama.290.11.1454-a

In Reply: Dr Levin-Scherz and Dr Yaes both point to the important role of financial incentives in determining the rate of spread of an innovation. In the framework of Everett Rogers, such incentives alter the "perceived advantage" of an innovation compared with the status quo.1 However, financial consequences are only part of the story. If they were adequate, why would hospitals, for example, not be rushing to use queuing theory to reduce delays in their own operating rooms, or streamlining documentation to avoid wasting the time of their nurses in useless recordkeeping, or standardizing treatment protocols to the best-known models—all of which save money and improve quality at the same time? The answer is that these require changes in behavior, attitudes, and systems that attenuate responses to incentives, alone.