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November 18, 1992

Quality Assessment of Quality Improvement Programs-Reply

Author Affiliations

The Johns Hopkins Hospital Baltimore, Md
University of California, Los Angeles

JAMA. 1992;268(19):2648. doi:10.1001/jama.1992.03490190048015

In Reply.  —We thank Dr Overfield for his letter, and we certainly agree that quality improvement programs need more evaluation as to their effectiveness. Indeed, William Rogers advocated 20 years ago that Medicare's peer review programs be implemented in an experimental or quasi-experimental way. However, we are more optimistic than Overfield about the value of identifying quality-of-care problems. Existing studies do not support the view that mistakes in health care are self-correcting. For example, a comprehensive study of the quality of ambulatory care demonstrated that physicians continue to make the same types of errors even when they have been alerted to them.1 In addition, many deficiencies in the quality are not due to physician errors per se, but rather to problems in the health care system or to mistakes made by other professionals. Finally, information on quality serves purposes other than feedback to physicians to help them improve quality