[Skip to Content]
[Skip to Content Landing]
June 16, 1989


JAMA. 1989;261(23):3408. doi:10.1001/jama.1989.03420230060015

To the Editor.—  Drs Iezzoni and Moskowitz have ably condensed 9 years of research and development of Medis-Groups, but the purpose of the key clinical findings and the process of their selection and collection deserve further clarification.1Our goal was to create a model of expert behavior and not to set criteria. I derived expert decision-making rules by observing the best clinicians teach residents at morning report. In most cases, the pivotal information was readily discernible. In a few cases, Dr Brewster and I had to assess the significance of what was observed in rounds. Knowledge of the subsequent clinical course simplified our assessments.To collect this information we still needed to translate telegraphic clinical communications transmitted at morning report into objective clinical findings collected in the record. For instance, when we observed that the chest roentgenographic finding of a lobar pneumonia led to a decision to use an