Should patients in quality-improvement activities have the same protections as participants in research studies?

To the Editor: Dr Casarett and colleagues1 raise appropriate concerns for protecting patients in local efforts to improve quality of care and propose criteria that extend current research protections to such quality improvement (QI) studies. However, we believe that such procedures could actually pose additional risks to patients and would interfere with efforts to address recent concerns about health care safety and quality.2 (October 11, 2000)