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Discussion about differences between research and improvement has a long history and understanding the distinction may have practical consequences. To protect patients, research, an optional activity, is regulated through institutional processes. But, improvement programmes within routine practice are not, usually, subjected to regulation. No improvement activity should put patients at risk. But should obligatory activities be scrutinised as research projects? These important issues are discussed by Lynn (p 67) and Doyal (p 11). Please enter this debate and send your views through the rapid response facility on the QSHC website,

Research findings feed into improvement work. Being able to link what is done to what happens to patients is crucial for choosing data to guide improvement work. Taking β blockers and aspirin after a heart attack is an effective intervention that increases survival. But as Bradley and colleagues describe (p 26), even in such an apparently simple example, getting data and feeding it back to clinicians so they feel able to use …

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