Medical practice variation: public reporting a first necessary step to spark change

Abstract

From previous work, we know that medical practice varies widely, and that unwarranted variation signals low value for patients and society. We also know that public reporting helps to create awareness of the need for quality improvement. Despite the availability of rich data, most Western countries have no routine surveillance of the geographic distribution of utilization, costs, and outcomes of healthcare, including trends in variation over time. This paper highlights the role of transparent public reporting as a necessary first step to spark change and reduce unwarranted variation. Two recent examples of public reporting are presented to illustrate possible ways to reduce unwarranted variation and improve care. We conclude by introducing the Value Improvement Cycle, which underscores that reporting is only a necessary first step, and suggests a path toward developing a multi-stakeholder approach to change.

Determinants and underlying causes of frequent attendance in midwife-led care: an exploratory cross-sectional study

“…In contrast, the performance statistics of the regression models on the entire study population and the subset of non-referred participants indicated that these models could not completely explain the occurrence of frequent attendance and could not be generalized to the underlying population of pregnant women in prenatal care. Different models might be obtained with a larger and different study population, adjusting for several relevant factors that were not included in this study [35, 36]; e.g. mental health was not included in our study, whereas women with a mental disability have more prenatal visits compared to women without [37].…”

Geographical variation in musculoskeletal surgical care in public hospitals in Ireland: a repeated cross-sectional study

“…The first step to address unwarranted variation in healthcare is the systematic, routine collation and publication of data on such variations 14. Detailed multivariable analysis of factors associated with musculoskeletal surgical variation in Ireland is required in order to establish if variation is unwarranted and if it is leading to inequitable access to publicly funded care.…”

Public needs for information disclosure on healthcare performance

“…[1–4] There is also a growing awareness that the public disclosure on practice variation is crucial for sparking change and improvement. [3,4] However, the accumulated crucial data and outcomes related to unwarranted practice variations are not necessarily disseminated to the stakeholders such as healthcare providers, policymakers, payers, and also, consumers including patients, families, and citizens. Westert et al have recently reported the structural difficulties in sharing the healthcare performance knowledge among stakeholders and suggested implementing “the Value Improvement Cycle,” which may close the gap between unwarranted healthcare variation and improving care.…”

“…Westert et al have recently reported the structural difficulties in sharing the healthcare performance knowledge among stakeholders and suggested implementing “the Value Improvement Cycle,” which may close the gap between unwarranted healthcare variation and improving care. [3]…”