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Article
November 13, 1987

Obtaining Clinical Data on the Appropriateness of Medical Care in Community Practice

Author Affiliations

From the Health Program, The Rand Corp (Drs Chassin and Brook, and Ms Oken), and Fink and Kosecoff Inc (Drs Kosecoff and Fink, and Mss Flynn, McCloskey, and Genovese), Santa Monica, Calif; and the Departments of Medicine (Drs Kosecoff, Fink, Solomon, and Brook) and Public Health (Drs Kosecoff, Fink, and Brook), University of California at Los Angeles.

From the Health Program, The Rand Corp (Drs Chassin and Brook, and Ms Oken), and Fink and Kosecoff Inc (Drs Kosecoff and Fink, and Mss Flynn, McCloskey, and Genovese), Santa Monica, Calif; and the Departments of Medicine (Drs Kosecoff, Fink, Solomon, and Brook) and Public Health (Drs Kosecoff, Fink, and Brook), University of California at Los Angeles.

JAMA. 1987;258(18):2538-2542. doi:10.1001/jama.1987.03400180072029
Abstract

We sought the voluntary cooperation of a randomly selected sample of community physicians and hospitals in five states for a study of how appropriately they performed coronary angiography, carotid endarterectomy, and upper gastrointestinal tract endoscopy. Ninety percent of 913 sampled physicians (n = 819) consented to a review of up to 20 of their 1981 Medicare patients' records. These physicians represented seven different specialties and subspecialties and performed 4988 procedures, 92% of the desired sample. Only three of 230 hospitals did not participate. We attribute our method's success primarily to the formation of a network to connect the branches of the profession, respect for office and hospital practice routine, confidentiality, and the develop ment of carefully designed medical record abstraction systems. We conclude that, with effort, cooperative research among disparate segments of the medical community can become a reality even if the topic studied is relatively sensitive.

(JAMA 1987;258:2538-2542)

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