In an attempt to update an important systematic review, I, too, was unable to find any randomized controlled trials (RCTs) which studied the effectiveness of parachute use to prevent death and major trauma related to gravitational challenge. The referenced tongue-in-cheek 2003 article by Smith and Pell had an important message: sometimes randomized controlled trials, despite being the gold standard of health services research, are not appropriate or possible for the study of all questions of interest. Common sense, however, which may be sufficient to draw conclusions on parachute use, may not be adequate when studying initiatives aimed at enhancing value within a health care system. Fortunately, quasi-experimental designs that do not employ randomization still can be used effectively to study the impact of major initiatives aimed at reducing costs and improving the patient experience.

In the “Practice...

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