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Philip Caper, MD
Dartmouth Medical School Codman Research Group Inc Hanover, NH

JAMA. 1988;259(13):1947.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.

—The article by Chassin et al¹ attempts to address a central question in the debate over the meaning of variations in the use of medical care among geographic areas. Unfortunately, the research design changes the terms of reference so drastically that it not only fails to answer the question it asked but in fact fails to address it.

First, the geographic areas used by Chassin et al were so large that variations in local use rates are masked. The range of variations between these large areas is many times smaller than within them. In contrast, the study of how discrete populations, defined around one or a small number of dominant hospitals, "consume" care can elucidate the practice patterns of local physicians and can facilitate communication and change.

Second, the ability to quantify practice patterns sheds important light on the nature of consensus-based agreement on clinical criteria. . . . [Full Text PDF of this Article]

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