COMMENTS AND RESPONSES Improvement Interventions

TO THE EDITOR: Davidoff's editorial (1) is absolutely correct in calling for the framework and statistics suitable for improve-ment activities rather than continuing to pretend that service delivery organization can be studied like a drug. If the ques-tion is how best can we learn to transition patients from hos-pital to home safely and with minimal need for short-term rehospitalization, quality improvement (QI) approaches are much more likely to succeed than research trials; they teach us much more about how the local system operates and what else might work, and they do so quickly. However, even if such a project dramatically decreased readmission rates and increased patient confidence and every other good thing that you would want to measure, it would not be published in Annals or any other major medical journal in the United States. It would not be funded by the National Institutes o