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From |
Michel Camus <mcamus@videotron.ca> |

To |
statalist@hsphsun2.harvard.edu |

Subject |
Re: st: comparing rates |

Date |
Mon, 08 Sep 2003 15:22:39 -0400 |

Matching design and variable (patient) seems confused with clustering factor (physician)... (see below)

Chris Rohlfs wrote:

Study question: do referral rates (possibly patterns) differ between practices (evidently composed of different physicians...)?don't worry about controlling for practice. you've already controlled for it with the doctor id (i.e., they're perfectly multicollinear). so just run: clogit referred, group(doctorid) and any possible confounding effects of "practice" will be captured & controlled for by doctorid. On Mon, 8 Sep 2003, Ricardo Ovaldia wrote:(...)

Can I simply take the number of referrals at one

practice and divide by the number of patients seen at

that practice (referral rate for practice 1) and

compare it to the rate of the other practice without

taking in account that some physicians within practice

may refer more than others? Or, should I compute the

referral rate for each physician, and then combine

these rates within practice by weighting them some

how? If so how can I do this in Stata? what kind of

weights should I use?

Ricardo. --- Ricardo Ovaldia <ovaldia@yahoo.com> wrote:

We are interested in comparing the referral rates

for two physician practices. The fist group has 20

physicians and the second group has 22 physicians.

Each physician saw a variable number of similar

patients some saw as few as 4 and others as many as

43. The physician either referred the patient to a

specialist or did not. If I compute the referral rate for each physician

group and compare them, I concerned because the

observations are not independent. (...) I though that I could use clogit- to group by

doctor ID: . clogit referred practice, group(doctorid)

This did not work because the practice-variable does

not vary within doctor ID, so it is dropped from the

model (omitted due to no within-group variance).

Any suggestions will be greatly appreciated.

=====

Ricardo Ovaldia, MS, Statistician, Oklahoma City, OK

Study design? ...panel or cohort study of 2 independent groups of physicians.

The relation between pratice (explanatory variable) and referral (outcome variable) is not matched/conditioned on physician since you do not have the same physicians in both practices. Therefore physician is not a matching variable. However, you may have matched/conditioned on (? Ricardo said "similar"...) patients to study the "practice effect" conditionally on (independently of) patient characteristics.

A) If so, you can condition on "patient", not on physician... (This will exclude a patient seen in one practice but not seen in the other.)

. clogit referred practice, group(patientid)

B) If not matched on patients, use ordinary unconditional -logit- or -logistic- but with the cluster option for physician.

The following should correct for the lack of independence of referrals by a same physician.

. logit referred practice, cluster(doctorid)

I tested this with a simulated dataset of 18 observations, which I attach. I hope this helps.

(Please, correct me if I am wrong.)

Michel Camus, PhD, epidemiologist

Health Canada

**Attachment:
ricardo ovaldia 8-09-2003.dta**

**References**:**Re: st: comparing rates***From:*Chris Rohlfs <car@uchicago.edu>

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