Parthiv J. Mahadevia, MD; Seth Himelhoch, MD; Joel Braunstein, MD
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Mahadevia P., Himelhoch S., Braunstein J.; Quality of Care in Patients with Diabetes. Ann Intern Med. 2002;137:70. doi: 10.7326/0003-4819-137-1-200207020-00019
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Published: Ann Intern Med. 2002;137(1):70.
TO THE EDITOR:
We applaud Greenfield and colleagues for demonstrating the confounding effects of physician-level clustering on quality assessments across provider groups (1). We disagree, however, with one of the study's major inferences: that endocrinologists and generalists do not significantly differ in the quality of patient diabetes care after adjustment for case mix and physician-level clustering.
Physician-level clustering limited the power of this study to detect major differences in care between endocrinologists and generalists. Still, the maximal likelihood estimations for most of the process and outcome measures suggested that endocrinologists offered favorable care. Physician-level clustering did not qualitatively change maximal likelihood estimates on any of the measures; it simply widened the confidence intervals. The failure to achieve “statistical significance” due to high variances should not necessarily minimize the importance of a consistent point estimate that suggests meaningful differences in care quality.
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