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Little evidence exists that large scale programmes to improve the
quality of health care bring important benefits or are worth the cost.
In the first of three articles on research to improve the quality of
health care, Øvretveit and Gustafson (p 759) describe research
designs that have proved successful in evaluating quality programmes
and highlight common failures of previous studies. Because these
quality programmes involve dynamic organisations and change over time,
the authors emphasise that their effectiveness is difficult to evaluate.