Exemplary Report and Missed Opportunities

The influence of worldview and the difficulty of overcoming our training

In reading the recent report by Kirkman et al. (1), I was simultaneously impressed and troubled. I was impressed by the attempt of this important work to improve the quality of care among seven rural primary care practices. Their detailed reporting of both initial and long-term results, and of both quality of care and physiological outcomes, was impressive. Especially noteworthy was their inclusion of longer-term, 2-year data, which are seldom reported. Their candor in discussing the failure to maintain the initial performance improvements, as well as their insightful discussion of potential reasons for these findings and the characteristics of systems that successfully improve quality, are refreshing and informative.

I was troubled, however, by the findings concerning the smoking cessation counseling index. I was struck by the validity of the observations of Kuhn (2) and Anderson …