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October 26, 2005

Quality Improvement Organizations and Hospital Care

JAMA. 2005;294(16):2028-2030. doi:10.1001/jama.294.16.2029-a

To the Editor: In their study of the effectiveness of QIOs in improving hospital care, Drs Snyder and Anderson1 reported that hospitals in the state of Washington that participated with our QIO improved more than nonparticipating hospitals for 11 of 13 quality indicators. Although the study did not have adequate power to evaluate the statistical significance of the individual measures at a state level, the consistent direction of the differences is highly unlikely to have occurred by chance alone (P = .011, based on a binomial distribution). As much as we would welcome the opportunity to cite this finding as evidence of the effectiveness of our work, serious methodological flaws in the study render the finding nearly meaningless.

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