, Volume 58, Issue 1, pp 1-4

Mind the Gap: Venous Thromboembolism Prophylaxis in Patients Hospitalized with Inflammatory Bowel Disease

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As you board the train in London, a sign reminds you to “Mind the Gap” and not stumble between the train and boarding platform. Improving the quality of medical care will take countless efforts to “Mind the Gap” between care that could be and care that is. Bridge enough gaps and perhaps we can cross the “Quality Chasm” that the Institute of Medicine’s 2001 report described [1].

In epidemiologic terms, the gap between best care and usual care is described by the terms “efficacy” and “effectiveness.” A. L. Cochrane, the British epidemiologist, first articulated this difference in his classic book entitled Effectiveness and Efficiency: Random Reflections on Health Service, the textbook that launched evidence-based medicine [2]. According to Cochrane, efficacy refers to the best care achievable when provided under ideal (controlled) conditions. Effectiveness refers to care that is provided under average or usual conditions.

In this issue of Digestive Diseases and Sciences, a gap in care is h