Bruce E. Landon, MD, MBA, MSc; Paul D. Cleary, PhD; Ira B. Wilson, MD, MSc
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Landon BE, Cleary PD, Wilson IB. Improving Improvement. Ann Intern Med. 2004;141:821-822. doi: 10.7326/0003-4819-141-10-200411160-00021
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Published: Ann Intern Med. 2004;141(10):821-822.
Dr. Batalden suggests that more information than was provided in our article is needed to understand how to improve QI interventions. We agree completely. A good evaluation study should first assess whether an intervention was successful (1). When there is no effect, a good study should provide information about how well the program was implemented, as well as information on potential moderating effects. Annals articles must be concise, and we could not include all of these details in our article. However, we did assess virtually all of the factors mentioned by Dr. Batalden. We conducted detailed assessments of the almost 1500 change initiatives attempted. We also surveyed clinicians and medical directors at each of the clinics both before and after the intervention to assess these factors, and we made site visits to a sample of clinics to collect qualitative data that might shed light on why the intervention was not more successful. Before publishing our evaluation, we conducted preliminary analyses of all of that information to assure ourselves that we were not misrepresenting the results or missing a critical determinant of success. We hope that subsequent analyses will improve our understanding of why the intervention described was not more successful.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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