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Sex Differences in Revascularization
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IN RESPONSE:
Dr. Groeneveld is correct to suggest that administrative data can often be used to generate useful information on disparities in access to care. He is also correct in highlighting that the need for detailed clinical information may not apply to all administrative databases nor to all potential research questions on issues of access and disparity of care. Given these valid comments, the challenge for researchers and readers then becomes how to know when an analysis is applying sufficiently detailed data to make meaningful conclusions.
Dr. Groeneveld has made two concrete recommendations: 1) Researchers should vigilantly identify and report the absence of potentially important covariates from their databases, and 2) readers of such studies should verify that all factors that may influence outcomes were incorporated in multivariate analyses. To these, we would add the following: 3) Readers and researchers should look for consistency of conclusions across studies and data sources [not seen in the issue of sex differences in access to cardiac care] because such consistency may increase the probability of valid findings, and 4) the developers of new clinical databases should strive to include as many relevant clinical predictors as possible and should also attempt to capture more information on newly recognized social determinants of health and health care delivery, such as income, education, housing, and social support. Greater attention to the latter factors will almost certainly enhance our understanding of disparities in health and health care.
Administrative data continue to be a valuable tool in this type of research, and researchers should not be discouraged from continuing to use these data to generate at least preliminary information on health care delivery and outcomes. This information can then be interpreted with attention to the points we and Dr. Groeneveld have raised and followed up with confirmatory research with more detailed clinical data sources, such as that used in our recent research.
- Copyright ©2004 by the American College of Physicians
