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Physician volume affects outpatient care

December 12, 2016

1. Physician volume may have a negative impact on quality of diabetes care


URLs go live when the embargo lifts

Primary care physicians with busier outpatient practices may deliver lower-quality diabetes care. The findings of a population-based cohort study are published in Annals of Internal Medicine.

Patient volume has been shown to affect quality of care delivered. A large U.S. study showed that high-volume surgeons had better mortality outcomes across 8 surgical procedures compared to their low-volume counterparts. Studies have also shown an association between high patient volume and better outcomes for heart failure and coronary artery disease. Much less is known about whether physician volume influences outcomes in the outpatient management of chronic diseases, such as diabetes.

Researchers conducted a population-based cohort study using data from provincial health care administrative databases in Ontario, Canada, which details virtually all care received by all residents of the province. This data was used to explore the associations of both overall ambulatory volume and diabetes-specific volume with quality of diabetes care among primary care physicians. Quality of diabetes care was measured over a two-year period using six indicators, including disease monitoring, prescription of medications, and adverse clinical outcomes. The study showed a clear and consistent association between primary care physician volume and quality of diabetes management. Patients of physicians with higher overall ambulatory volumes had consistently lower quality care. However, higher diabetes-specific volume was associated with higher quality of care across all six indicators. These results show that the relationship between physician volume and quality can be extended from acute care to outpatient chronic disease care.

Note: For an embargoed PDF, please contact Cara Graeff. To reach the lead author, Dr. Baiju Shah of ICES in Toronto, Ontario, Candada, please contact Deborah Creatura or 416-480-4780.

2. Author confronts intellectual thief in "Dear Plagiarist" letter

Annals reviewer stole research and published it as his own



A powerful letter published in Annals of Internal Medicine confronts the plagiarist who stole the author's scientific research paper and tried to pass it off as his own. The thief had served as an external reviewer on the paper when it was submitted to Annals of Internal Medicine for consideration to be published. When the paper was rejected, the reviewer reproduced the text, tables, and figures, fabricated a cohort of European patients that did not exist, and found multiple "co-authors" willing to sign their names to the fraudulent research. According to Michael Dansinger, MD, author of the letter, the research paper represented 5 years of work from conceptualization of the study to publication of the primary analysis.

Christine Laine, MD, MPH, editor-in-chief of Annals of Internal Medicine, decided to publish Dr. Dansinger's letter to assure readers that Annals takes such matters very seriously and to serve as an example that might deter such misbehavior in the future. In an equally candid letter, Dr. Laine explains the process by which the plagiarism was discovered and the actions taken by Annals of Internal Medicine to bring the scientific misconduct to light.

Note: For an embargoed PDF, please contact Cara Graeff. To reach the author, Dr. Michael Dansinger at Tufts Medical Center in Boston, please contact Jeremy Lechan at or 617-636-0104. To reach Dr. Christine Laine from Annals of Internal Medicine, please contact Angela Collom.

3. "Repeal and replace" talk ignores the complexities of the health care system

Working class and women among those most likely to be affected by ACA repeal


President-elect Donald Trump has promised to "repeal and replace" the Affordable Care Act (ACA) and will likely have the votes to do so. However, health care is complicated and even talk of repeal is disruptive to the industry because planning and business decisions have assumed that the ACA would remain in place. According to Robert Doherty, Senior Vice President for Governmental Affairs and Public Policy for the American College of Physicians (ACP), the demise of the ACA will have direct, real, and personal consequences for many Americans. His Ideas and Opinions piece is published in Annals of Internal Medicine.

More specifically, the GOP may be planning to "repeal, delay, and replace," the ACA, which means passing a repeal of the law without having a developed replacement plan in place. Mr. Doherty cautions that with this approach uncertainty about the ACA's replacement is likely to cause most insurers to exit the ACA's insurance markets by the end of 2017, causing as many as 10 million people to suddenly lose their coverage. This would likely create a bigger political firestorm than when the ACA required approximately 4 million people to switch to a different plan in 2013. The people most likely to be affected by repeal include working class people, women who are concerned about loss of coverage for contraception, and those with preexisting medical conditions who may once again find themselves turned away by insurers. Mr. Doherty suggests that their voices need to be heard.

Note: For an embargoed PDF, please contact Cara Graeff. To speak with the author, Robert Doherty, BA from the American College of Physicians, please contact David B. Kinsman, APR at or 202-261-4554.
Also new in this issue:

Outcomes-Based Pricing as a Tool to Ensure Access to Novel but Expensive Biopharmaceuticals

Daniel M. Blumenthal, MD, MBA; Dana P. Goldman, PhD; and Anupam B. Jena, MD, PhD

Ideas and Opinions


American College of Physicians

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