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Letters |5 July 2016

Outcomes of Basic Versus Advanced Life Support for Out-of-Hospital Medical Emergencies

Prachi Sanghavi, PhD; Anupam B. Jena, MD, PhD; Joseph P. Newhouse, PhD; Alan M. Zaslavsky, PhD

Article, Author, and Disclosure Information
Author, Article, and Disclosure Information
  • From University of Chicago, Chicago, Illinois, and Harvard Medical School, Boston, Massachusetts.

    Grant Support: By a National Science Foundation Graduate Research Fellowship (Dr. Sanghavi), an Agency for Healthcare Research and Quality grant (1R36HS022798-01; Dr. Sanghavi), and the National Institutes of Health Early Independence Award (1DP5OD017897-01; Dr. Jena).

    Disclosures: Dr. Jena receives personal fees as a principal consultant to Precision Health Economics. Dr. Newhouse is a director of, and holds equity in, Aetna. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-0557.

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IN RESPONSE:
Although we agree with Dr. Soumerai that randomized trials of prehospital care would be useful, they are unlikely to be done. In their absence, the best available observational study designs must be used. We disagree with Dr. Soumerai's characterization of all IV designs as weak. Just as applications of the difference-in-differences designs that Dr. Soumerai favors may vary in strength, so too do IV applications.
The key untestable assumptions for valid IV analyses are that the instrument affects the dependent variable only through the variable being instrumented for and is uncorrelated with omitted predictors of the outcome (...
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Sanghavi P, Jena AB, Newhouse JP, et al. Outcomes of Basic Versus Advanced Life Support for Out-of-Hospital Medical Emergencies. Ann Intern Med. 2016;165:69–70. doi: https://doi.org/10.7326/L15-0628

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Published: Ann Intern Med. 2016;165(1):69-70.

DOI: 10.7326/L15-0628

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2016 American College of Physicians
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704

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