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Reliance on the unembellished metrics and austere research design of the randomized controlled trial has far-reaching implications not only for health but for entire health care infrastructures. Drawing from research in the largest integrated health care system in the United States, the Veterans Health Administration, this chapter examines some of the challenges of bringing qualitative data and research methodologies to bear within the politically charged, outcome-driven context of a U.S. government institution. An rct among veterans with spinal cord injury serves as a case study for this chapter. While these models decipher certain outcomes and can determine optimal modes of care, the unqualified promotion of metric quantification is obstructive to case-specific quality and the broader social context of health.

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