Obtaining Clinical Data on the Appropriateness of Medical Care in Community Practice

by Jacqueline Kosecoff, Mark R. Chassin, Arlene Fink, Mary Frances Flynn, Lois McCloskey, Barbara Genovese, Carole Oken, David Solomon, Robert H. Brook

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Abstract

The authors sought the voluntary cooperation of a randomly selected sample of community physicians and hospitals in five states for a study of how appropriately they performed coronary angiography, carotid endarterectomy, and upper gastrointestinal tract endoscopy. Ninety percent of 913 sampled physicians (n=819) consented to a review of up to 20 of their 1981 Medicare patients' records. These physicians represented seven different specialties and subspecialties and performed 4,988 procedures, 92 percent of the desired sample. Only three of 230 hospitals did not participate. The authors attribute their method's success primarily to the formation of a network to connect the branches of the profession, respect for office and hospital practice routine, confidentiality, and the development of carefully designed medical record abstraction systems. They conclude that, with effort, cooperative research among disparate segments of the medical community can become a reality even if the topic studied is relatively sensitive.

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