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Sheldon Greenfield, MD; Alvin R. Tarlov, MD; John E. Ware, Jr, PhD
Boston, Mass

Richard L. Kravitz, MD
Los Angeles, Calif

Eugene C. Nelson, ScD
Nashville, Tenn

Michael Zubkoff, PhD
Hanover, NH

JAMA. 1992;268(12):1538-1539.

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

In Reply.

—We agree with Drs Lasker and Shapiro that describing the mix of patients seen in different systems of care and by different specialists is important. In our article on the mix of patients among medical specialties and systems of care,¹ we documented differences in socioeconomic status, number and type of chronic diseases, clinical severity of some of the more prevalent conditions, and finally, general health status in terms of functioning and well-being. Resource use was not equivalent in the cross-sectional part of the MOS even after applying these controls. However, until we know whether these different levels of utilization are associated with different patient outcomes, we cannot address the issue of appropriateness.

Our conclusions regarding differences in resource utilization rest on the adequacy of case mix (or as we prefer to call it, patient mix) and adjustment, which Lasker and Shapiro question. Specifically, they express concern about . . . [Full Text PDF of this Article]

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