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Donald J. Venes, MD
Spartanburg (SC) Regional Medical Center

JAMA. 1993;269(23):2985.

	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.

—In a thought-provoking study of clinical quality assurance, Mennemeyer and Winkelman¹ have shown that laboratories that perform more tests, in states with stricter laboratory oversight, generate PT results that foster better patient care. Their findings, which result from an analysis of Medicare records, raise important concerns about the reliance of third-party payers, physicians, and patients on results reported by small, poorly regulated physician office laboratories.

While the authors' conclusions are plausible and potentially of great social significance, I am concerned about several important technical issues raised by this article. Contrary to the authors' statement "that there are generally no other independent clinical or laboratory measures of anticoagulant therapy status [other than the PT]," the INR does serve as such a measure and was well acknowledged as a standard of laboratory evaluation during the period of this study (1985 through 1987).^2,3 Reliance on the PT instead . . . [Full Text PDF of this Article]

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