REPLY
Quality of Care in Patients with Diabetes
The Editors
2 July 2002 | Volume 137 Issue 1 | Page 72
IN RESPONSE:
Drs. Cobin and Rodbard expressed disappointment in the Summary for Patients (1) that accompanied Greenfield and colleagues' article (2). The Editors respectfully disagree with their assertions that the summary uncritically accepted the paper's conclusions, extrapolated to physicians' practices in general, and oversimplified facts. Contrary to our correspondents' view, the summary drew no conclusions about which type of physicians provide the best diabetes care. Rather, it concluded that without analyses that consider patient factors and physician-level clustering, one might come to erroneous conclusions about the care provided by different types of doctors. The summary did not overgeneralize but clearly cautions readers that the findings in the 29 study sites might not apply to other settings. Last, we do not feel that the summary oversimplified the facts. The Editors try to write the summaries at a level that permits them to be accessible to a large proportion of the public. In this case, we presented in plain language a difficult methodologic issue about comparisons among physician groups. We feel that the summary clearly conveys the paper's essential message that comparing care among groups of physicians is difficult to do because of the many patient, doctor, and practice factors that influence such comparisons.
1. Summaries for patients. Comparing the quality of diabetes care by generalists and specialists Ann Intern Med. 2002;136:42 [PMID: 11928735].
2. Greenfield S, Kaplan SH, Kahn R, Ninomiya J, Griffith JL. Profiling care provided by different groups of physicians: effects of patient case-mix (bias) and physician-level clustering on quality assessment results Ann Intern Med. 2002;136:111-21. [PMID: 11790062].
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