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Patient mix and utilization of resources.

To the Editor. —Two recent articles described results from the Medical Outcomes Study. 1,2 Significant differences were reported in the mix of patients among medical specialties and in resource utilization among specialties controlling for patient mix. We are troubled by problems in the diagnostic accuracy, lack of specificity, and the authors' use of the measures of clinical severity for patients with hypertension, diabetes mellitus, recent myocardial infarction, and congestive heart failure. It appears that patients were assigned diagnostic labels based on physician reports. Was any attempt made to validate the accuracy of the diagnosis? Were any laboratory data collected that document that the patient had the diagnosis assigned by the physician? Is it possible that some physicians were more accurate in their diagnoses than others? The instruments used to measure disease severity lack specificity. The cause is not stated for either congestive heart failure or hypertension although cause is important