The rigorous nature and timeliness of the peer review process and the quality of papers submitted to JAMA are reflected in several key measures (Table). Over the past 5 years, JAMA's impact factor4 has continued to increase steadily; for 2004, the latest available value, our impact factor was 24.8. In addition, with full implementation of our Web-based system for manuscript submission and peer review in early 2005, the turnaround times for editorial decisions have continued to decrease. For instance, the mean time for reviewers to complete their reviews decreased from 26 days in 2004 to 13 days (median, 12 days) in 2005. Moreover, the overall mean publication time, ie, from manuscript submission to publication, is now 115 days (median, 110 days). With an increased number of submitted papers, the overall acceptance rate (including solicited papers, such as editorials and commentaries) has declined to approximately 8%. However, for submitted papers of good quality that cannot be published in JAMA, authors may be given the option of having their paper (along with the peer reviews) referred to one of our family of ARCHIVES specialty journals for further consideration.