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November 22, 1995

Quality of Outpatient Care: Diabetes-Reply

Author Affiliations

Johns Hopkins School of Public Health Baltimore, Md
Project Hope Bethesda, Md
Brandeis University Waltham, Mass
Park Nicollet Medical Foundation Minneapolis, Minn
Harvard School of Public Health Boston, Mass

JAMA. 1995;274(20):1585. doi:10.1001/jama.1995.03530200020019

In Reply.  —We agree with Drs Bowman and Konen that education and patient compliance are essential ingredients to the care process. We also agree that recommended practice guidelines should not be applied blindly to all patients in all instances. However, we and others concerned with quality of primary care in the United States continue to support the premise that patient outcomes would be improved if physician groups and health plans work together to identify and monitor "essential" process and outcome indicators deemed to be generally applicable to most patients.Dr Clemenson's comments point to the critical importance of continued development of guidelines based on cost-benefit evidence. But given that this research is not now—and may never be—complete, we believe that medical leaders and those responsible for managing society's limited resources must use the best available research to offer applied guidelines to practitioners. Our clinical panels and many other national experts

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