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Context variables, summarized in center, show little impact in variability. And physician related factors are only relevant in pediatric population.
Some other variables not recorded and measurement error may play a role in the observed variability. The accumulation of different kind of errors may be heterogeneous among centers and professionals. The main sources of errors are: deficient quality in patient record files, errors in diagnostic coding and in recoding from ICPC-2 to ICD-9-MC.