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John E. Wennberg, Elliott S. Fisher, Laurence Baker, Sandra M. Sharp, and Kristen K. Bronner, Evaluating The Efficiency Of California Providers In Caring For Patients With Chronic Illnesses, Health Affairs Web Exclusive, November 16, 2005 [Abstract] [PDF] [HTML Version][Appendix Figure 1][Table of Contents] [Reprints & Permissions]

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What Does the Study Really Prove

Gerald E. Cole   ( 7 December 2005 )

What Does the Study Really Prove 7 December 2005
Gerald E. Cole, Special Counsel for Employee Benefits Research Milliman Send comment to journal: Re: What Does the Study Really Prove gerrycole2{at}aol.com Gerald E. Cole	I found the study quite interesting and enlightening. One critical question that I did not see addressed, though, was the effect of increased treatment intensity on prolonging life. Because the study looked only at those patients who died, I was unable to determine if its conclusion that greater utilization of speciality and ICU services did not improve outcomes applies to the entire population served. It is not surprising that for patients who died, the extra care did not result in extending life or improving its quality, but an equally important question is whether the extra care resulted in a smaller proportion of patients with similar conditions dying, and the extent to which the extra care improved the quality of their lives. For example, the study does not capture even those patients who eventually died shortly after the period covered by the study. Because of this lack of information, it would be improper to conclude from the study that more intensive interventions are generally a waste of resources. I look forward to additional studies aimed at answering this critical question.