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March 4, 1998

Potentially Ineffective Care in Intensive Care

Author Affiliations

Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor

JAMA. 1998;279(9):651-654. doi:10-1001/pubs.JAMA-ISSN-0098-7484-279-9-jbk0304

To the Editor.—Drs Cher and Lenert1raise important questions about the effect of Medicare HMOs on intensive services in potential end-of-life situations. Their hypothesis, that physicians reimbursed by managed care are less likely to provide inappropriate high-intensity care, is intriguing, and their statistical methods are appropriately sophisticated; however, we must question the understanding of the underlying data on which the study is based. The authors commented on some information that was unavailable to them, and the accompanying Editorial2 remarked on several points on which caution should be taken in interpreting the study, but there are other issues that affect the generalizability of the results of the study.