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September 23, 1992

Specialists or Generalists? The Medical Outcomes Study-Reply

Author Affiliations

Boston, Mass
Los Angeles, Calif
Nashville, Tenn
Hanover, NH

JAMA. 1992;268(12):1538-1539. doi:10.1001/jama.1992.03490120051018

In Reply.  —We agree with Drs Lasker and Shapiro that describing the mix of patients seen in different systems of care and by different specialists is important. In our article on the mix of patients among medical specialties and systems of care,1 we documented differences in socioeconomic status, number and type of chronic diseases, clinical severity of some of the more prevalent conditions, and finally, general health status in terms of functioning and well-being. Resource use was not equivalent in the cross-sectional part of the MOS even after applying these controls. However, until we know whether these different levels of utilization are associated with different patient outcomes, we cannot address the issue of appropriateness.Our conclusions regarding differences in resource utilization rest on the adequacy of case mix (or as we prefer to call it, patient mix) and adjustment, which Lasker and Shapiro question. Specifically, they express concern about