Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorJody W.ZylkeMD, Contributing EditorIndividualAuthor
To the Editor: Dr Asch and colleagues1 highlighted the problem of underuse, but their reliance on opinion to define "necessary care" weakens their findings.
For 29 of 41 indicators (71%), necessity was determined from expert opinion. Asch et al based only 5 indicators on randomized trials and, because they did not reference the specific articles, it is unclear even for these indicators whether the studies provide direct scientific support. For example, it is uncertain which trial supports the need for patients with diabetes to have glycosylated hemoglobin measurements every 6 months. The landmark trial that established the benefits of intensive glycemic control did so with annual testing.2
Woolf SH, Rothemich SF. Overuse of Administrative Data to Measure Underuse of Care. JAMA. 2001;285(6):735-737. doi:10-1001/pubs.JAMA-ISSN-0098-7484-285-6-jlt0214