Time was not included in the model as a fixed effect because previous analyses of these data have not shown a significant trend over time relative to intermediate outcomes. 21 Consequently, the focus of this analysis was within practice fluctuations in intermediate outcomes rather than systematic change in intermediate outcomes. 36 The intercept and the effect of within practice patient care were allowed to vary randomly.
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Importance of an alternative approach to measuring quality in a volume-to-value world: a case study of diabetes care.
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