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October 3, 2001

Relationship of Physician Volume to Mortality After Acute Myocardial Infarction—Reply

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorJody W.ZylkeMD, Contributing EditorIndividualAuthor

JAMA. 2001;286(13):1574-1575. doi:10.1001/jama.286.13.1573

In Reply: Dr Campbell suggests that unmeasured selection bias accounts for the higher mortality rates of lower-volume physicians in our recent study of the relationship between the annual volume of patients treated by the admitting physician and mortality after AMI. Although we acknowledged in our article that we could not account for every possible confounding factor (eg, time to hospital presentation, presence of depression), we did adjust for a number of important prognostic factors influencing AMI mortality, including patient's age, sex, comorbidity, and socioeconomic status; physician characteristics, including specialty; and hospital characteristics, including volume, and still found a consistent volume-outcome relationship for physicians, using advanced statistical methods including hierarchical models and propensity scores. The usefulness of our administrative data-based risk-adjustment models have also been validated in other settings.1