Quality of Care in Patients with Diabetes

Sheldon Greenfield; Sherrie H. Kaplan; Richard Kahn

doi:10.7326/0003-4819-137-1-200207020-00022

Letters |2 July 2002

Quality of Care in Patients with Diabetes

Sheldon Greenfield, MD; Sherrie H. Kaplan, PhD, MPH; Richard Kahn, PhD

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IN RESPONSE:

Mahadevia and associates underscore the importance of understanding the central point of our paper, that is, that variation between physicians (physician-level clustering) can limit the power of studies comparing any groups of physicians (for example, fee-for-service vs. managed care settings or high-quality vs. low-quality practice settings). All studies attempting such comparisons must be designed with not only sufficient numbers of patients per physician but also sufficient numbers of physicians per comparison group to ensure adequate power. The analytic methods we used were specifically chosen to investigate the separate effects of adjustment for patient characteristics and then physician clustering on observed differences, holding differences constant (1). The point estimates therefore did not change. It was the variability between physicians in each group rather than differences in case mix that accounted for the lack of statistical significance between groups. A recent study (2) showed similar findings when comparisons of groups of hospitals were adjusted for within-group variability.

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2002 American College of Physicians

Letters |2 July 2002

Quality of Care in Patients with Diabetes

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Letters |2 July 2002

Quality of Care in Patients with Diabetes

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