The analytical methods are much the same as in our published comparison of FRACGPs with non
FRACGP VRGPs in Medical Care. see: Miller G, Britt H, Pan Y, Knox S 2004. Relationship
between general practitioner certification and characteristics of care. Med Care 42(8):770-778.
An interesting recent report from the Centers for Disease Control and Prevention, National Center
for Health Statistics (NCHS) may be of interest to you.
"Assessing the potential of national Strategies for Electronic Health
Records for Population Health Monitoring and Research".
It can be downloaded from
http://www.cdc.gov/nchs/data/series/sr_02/sr02_143.pdf
The Summary and Highlights (pages vii-xii) bring it all together.
Graeme Miller
On 10 Jul 2007 at 12:20, Tim Churches wrote:
>
> This report seems to belie your experience:
> http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=545648 -
> they are reporting design effects of between 6 and 45 for single
> variables - that is, the effective sample size is between 6 and 45
> times smaller than the actual sample, and Deffs of between 2 to 5 for
> association intra-class correlation i.e. effective sample sizes of
> half to a fifth of the actual sample size.
>
> Given design effects of this magnitude, I agree that these days there
> is no excuse for not taking the sampling design into account when
> fitting statistical models to cluster-sampled data like the BEACH
> data. Maybe they did that, but there was no mention of it in the
> abstract or the presentation.
>
> Also, if you analyse only the proportion of patients meeting some
> criteria for each GP (that is, analyse only at the GP level and not
> the individual patient level), then you are wasting huge amounts of
> information and interpretation must be very circumspect because of the
> possibility of serious ecological fallacy, or Simpson's paradox if you
> like.
>
>
> Yes, I think that there are many methodological issues to which too
> little attention is paid in general practice research. I am not saying
> that the presentation we are discussing is guilty of such lack of
> attention, but I can't say for certain because not enough information
> about the methods is reported.
>
> Anyway, this is a useful discussion which underlines the desirability
> of collecting as much data as possible, electronically, as everyone
> has been pointing out.
>
> Tim C
**********************************
Associate Professor Graeme Miller MB BS PhD FRACGP
Medical Director
Family Medicine Research Centre
(A Collaborating Centre of the World Organisation of Family Doctors)
University of Sydney
Level 7 16-18 Wentworth St
Parramatta NSW Australia
Mail: Westmead Hospital
Westmead NSW 2145
Australia
Medical Director
Australian General Practice Statistics and Classification Centre
Australian Institute of Health and Welfare/
University of Sydney
Phone +61 2 9845 8156
Mobile 0412 465 585
Fax +61 2 9845 8155
Skype name: graymil
Email
[EMAIL PROTECTED]
Web
http://www.fmrc.org.au
***********************************************************************
This e-mail, including any attachments sent with it, is confidential and
for the sole use of the intended recipient(s). This confidentiality is not
waived or lost if you receive it and you are not the intended
recipient(s), or if it is transmitted/ received in error.
Any unauthorised use, alteration, disclosure, distribution or review of
this e-mail is prohibited. It may be subject to a statutory duty of
confidentiality if it relates to health service matters.
If you are not the intended recipient(s), or if you have received this
e-mail in error, you are asked to immediately notify the sender by
telephone or by return e-mail. You should also delete this e-mail message
and destroy any hard copies produced.
**********************************************************************
_______________________________________________ Gpcg_talk mailing list [email protected] http://ozdocit.org/cgi-bin/mailman/listinfo/gpcg_talk
