In Reply We agree with the letter writers that our study1 design is observational and that assessment of definitive causality in all observational studies is difficult. We also agree that unmeasured confounding may persist in our study, although we did attempt to address this with multiple sensitivity analyses, including analyses focused on patient complexity, severity of illness, and hospital-level and physician-level effects. However, our finding that patients cared for by physicians familiar with them had lower mortality 30 days after admission than patients cared for by other types of physicians is important and deserves further study.
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Stevens JP, Nyweide DJ, Landon BE. Concerns Regarding Resource Use and Outcomes in Subsets of Clinicians—Reply. JAMA Intern Med. 2018;178(4):581. doi:10.1001/jamainternmed.2018.0184
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