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Comment & Response
April 2018

Concerns Regarding Resource Use and Outcomes in Subsets of Clinicians—Reply

Author Affiliations
  • 1Center for Healthcare Delivery Science, Beth Israel Deaconess Medical Center, Boston, Massachusetts
  • 2Division for Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
  • 3Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, Baltimore, Maryland
  • 4Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
  • 5Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts
JAMA Intern Med. 2018;178(4):581. doi:10.1001/jamainternmed.2018.0184

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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