Abstract
The bloom is off the rose, at least partially. From the time they emerged in the 1940s as a substantial advance over available research designs, randomized, controlled trials (RCTs) quickly became the gold standard for testing medical interventions. However, it has long been acknowledged that for some interventions, particularly programs with multiple components or those intended for broad application or implementation when generalizability is of primary concern, RCTs for a variety of reasons either cannot be performed or are of less value than other research designs. A recent Institute of Medicine roundtable compendium encouraged movement toward increasingly sophisticated research designs other than RCTs to assess quality improvement or patient-safety initiatives.1–3 Rigorous evaluations of programs such as the California Asthma Among the School-aged (CAASA) project face the challenges and tensions inherent in testing the effectiveness of multiple-component interventions that are intended to be applied to highly disparate patient populations, widely varied clinical venues, … Address correspondence to Sheldon Greenfield, MD, Center for Health Policy Research, Department of Medicine, 111 Academy, Suite 220, Irvine, CA 92697. E-mail: sgreenfi{at}uci.edu
Published Version
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