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Barry Saver, MD, MPH

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Sequist et al¹ present interesting findings on racial variations in intermediate outcomes for diabetes among patients seen in one integrated group practice. The authors are to be lauded for assessing measures of control rather than the usual suspects of tests performed. However, even though the authors point out that partitioning variation into between-physician and within-physician components "may not capture the full spectrum of explanatory factors related to differential outcomes within a physician's panel . . . " and " . . . should not be used to assign sole responsibility to an individual physician . . . ,"^1(p1146) I believe that the authors proceed too far in that direction in their conclusions, perhaps too easy to do when discussing the rubric of "within-physician variation." Statistically, what the authors refer to as "within-physician variation" is all the difference between black and white patients that is not explained by measured patient characteristics (with sociodemographic measures obtained from administrative data being . . . [Full Text of this Article]

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RELATED ARTICLE

Physician Performance and Racial Disparities in Diabetes Mellitus Care
Thomas D. Sequist, Garrett M. Fitzmaurice, Richard Marshall, Shimon Shaykevich, Dana Gelb Safran, and John Z. Ayanian
Arch Intern Med. 2008;168(11):1145-1151.
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Racial Disparities in Diabetes and Physicians: Lack of Association Does Not Indicate Cause or Cure—Reply
Thomas Dean Sequist, Garrett M. Fitzmaurice, Richard Marshall, Shimon Shaykevich, Dana Gelb Safran, and John Z. Ayanian
Arch Intern Med. 2009;169(2):204.
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