ArticleBMC health services research2005
The role of 'confounding by indication' in assessing the effect of quality of care on disease outcomes in general practice: results of a case-control study.
Article in BMC health services research, 2005. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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Who cites it
9 citing papers in PubMed, 32 citations in OpenAlex.
- Observational
- Association between antithrombotic treatment and hemorrhagic stroke in patients with atrial fibrillation-a cohort study in primary care.European journal of clinical pharmacology · 2017Article
- Warfarin treatment and risk of myocardial infarction - A cohort study of patients with atrial fibrillation treated in primary health care.International journal of cardiology · 2016Observational
- Guideline adherence and health outcomes in diabetes mellitus type 2 patients: a cross-sectional study.BMC health services research · 2015Article
- Pregnancy-specific stress, preterm birth, and gestational age among high-risk young women.Health psychology : official journal of the Division of Health Psychology, American Psychological Association · 2014Article
- Effects of prescribed antithrombotics and other cardiovascular pharmacotherapies on all-cause mortality in patients with diabetes and atrial fibrillation - a cohort study from Sweden using propensity score analyses.Diabetology & metabolic syndrome · 2014Article
- Effect of cardiovascular drug classes on all-cause mortality among atrial fibrillation patients treated in primary care in Sweden: a cohort study.European journal of clinical pharmacology · 2013Article
- Prior antimicrobial therapy and risk for hospital-acquired Candida glabrata and Candida krusei fungemia: a case-case-control study.Antimicrobial agents and chemotherapy · 2005Article
- Warfarin treatment and risk of stroke among primary care patients with atrial fibrillation.Scandinavian cardiovascular journal : SCJObservational
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6 authors at 3 institutions in 1 country.
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Abstract
backgroundIn quality of care research, limited information is found on the relationship between quality of care and disease outcomes. This case-control study was conducted with the aim to assess the effect of guideline adherence for stroke prevention on the occurrence of stroke in general practice. We report on the problems related to a variant of confounding by indication, that may be common in quality of care studies.
methodsStroke patients (cases) and controls were recruited from the general practitioner's (GP) patient register, and an expert panel assessed the quality of care of cases and controls using guideline-based review criteria.
resultsA total of 86 patients was assessed. Compared to patients without shortcomings in preventive care, patients who received sub-optimal care appeared to have a lower risk of experiencing a stroke (OR 0.60; 95% CI 0.24 to 1.53). This result was partly explained by the presence of risk factors (6.1 per cases, 4.4 per control), as reflected by the finding that the OR came much closer to 1.00 after adjustment for the number of risk factors (OR 0.82; 95% CI 0.29 to 2.30). Patients with more risk factors for stroke had a lower risk of sub-optimal care (OR for the number of risk factors present 0.76; 95% CI 0.61 to 0.94). This finding represents a variant of 'confounding by indication', which could not be fully adjusted for due to incomplete information on risk factors for stroke.
conclusionsAt present, inaccurate recording of patient and risk factor information by GPs seriously limits the potential use of a case-control method to assess the effect of guideline adherence on disease outcome in general practice. We conclude that studies on the effect of quality of care on disease outcomes, like other observational studies of intended treatment effect, should be designed and performed such that confounding by indication is minimized.
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