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April 10, 1996

The Medical Outcomes Study-Reply

Author Affiliations

The Health Institute New England Medical Center Boston, Mass

JAMA. 1996;275(14):1084-1085. doi:10.1001/jama.1996.03530380025018

In Reply.  —Dr Testa and Dr Matz agree with our statement that in some cases the numbers of patients were small and precision was limited. However, our general conclusions are based on aggregated numbers of hypertensive and diabetic patients and aggregated measures. If clinicians in some system or specialty ignored or wrongly treated hypertension or NIDDM, notable deterioration would be expected.1 We found little evidence of either poor outcomes or lack of care. The clinical index goes a long way toward eliminating the numbers problem. Hidden behind the small samples of patients is a much larger sample of nearly uncorrelated clinical measurements that we aggregated into a clinical index. An index can find small differences that appear in many measurements but not medium-sized differences on a single measurement such as HbA1c. Basing power on each individual measure would be needlessly expensive.Contrary to Testa's implication, we did control