Sociological Model for Understanding Medical Practice Variations

Jong, J.D. de; Groenewegen, Peter; Westert, Gert P.

doi:10.1007/978-1-4899-7573-7_159-1

Cited by 8 publications

(14 citation statements)

References 46 publications

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“…56 However, the 'correct rate' remained unknown, as differences depend on other factors such as culture, refuge to alternative treatments like antibiotics, the type of healthcare system (easy access to care, high or low costs per person) and socio-economic status, which were not studied in most included articles. [59][60][61]…”

Section: International Variation In Tonsil Surgery Ratesmentioning

confidence: 99%

The impact of new evidence on regional variation in paediatric tonsillectomy and adenoidectomy: a historical review

et al. 2020

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BackgroundTonsillectomy and adenoidectomy have been among the most commonly performed procedures in children for approximately 100 years. These procedures were the first for which unwarranted regional variation was discovered, in 1938. Indications for these procedures have become stricter over time, which might have reduced regional practice variation.MethodsThis paper presents a historical review on practice variation in paediatric tonsillectomy and adenoidectomy rates. Data on publication year, region, level of variation, methodology and outcomes were collected.ResultsTwenty-one articles on practice variation in paediatric tonsil surgery were included, with data from 12 different countries. Significant variation was found throughout the years, although a greater than 10-fold variation was observed only in the earliest publications.ConclusionNo evidence has yet been found that better indications for tonsillectomy and adenoidectomy have reduced practice variation. International efforts are needed to reconsider why we are still unable to tackle this variation.

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Section: International Variation In Tonsil Surgery Ratesmentioning

confidence: 99%

The impact of new evidence on regional variation in paediatric tonsillectomy and adenoidectomy: a historical review

et al. 2020

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“…At the clinician level, when doctors are faced with discretionary decisions in standardized vignettes describing a clinical case, their choices correlate with local health status adjusted utilization levels [3, 4]. Clinicians adhere to local standards of care, with the local supply of resources acting as one of the dominant drivers of utilization [5]. As pointed out by Mulley, ‘Clinicians become accustomed to standard clinical policies that have been shaped over time by local capacity and are often surprised to learn that they are radically different from those in other regions.’ [6] Mapping and reporting regional patterns and investigating geographic differences in medical utilization are essential for recognizing problems and developing policies and practices that increase the value of healthcare.…”

Section: Introductionmentioning

confidence: 99%

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

Westert¹,

Groenewoud²,

Wennberg

et al. 2018

International Journal for Quality in Health Care

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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.

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“…3 8 9 In explaining this variation research, therefore, focuses on the role of physicians and the patients’ influence receives little attention. 10 11 Research showed that variation, among others, can be explained by differences in opinions on or enthusiasm for certain procedures between individual physicians, and by differences in constraints and social influences on groups of physicians, for example, between hospitals. 9 11–14 In the past decades, however, the paternalistic model has been questioned.…”

Section: Introductionmentioning

confidence: 99%

“… 10 11 Research showed that variation, among others, can be explained by differences in opinions on or enthusiasm for certain procedures between individual physicians, and by differences in constraints and social influences on groups of physicians, for example, between hospitals. 9 11–14 In the past decades, however, the paternalistic model has been questioned. Also, the position of patients in healthcare has significantly altered.…”

Section: Introductionmentioning

confidence: 99%

“… 23 29–31 However, no clear evidence about the association between SDM and medical practice variation is available as yet. 11 There is no research which has identified exactly how or why SDM might reduce this variation. Therefore, this study further elaborates on the mechanisms that may explain why SDM reduces medical practice variation.…”

Section: Introductionmentioning

confidence: 99%

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Does a strategy to promote shared decision-making reduce medical practice variation in the choice of either single or double embryo transfer after in vitro fertilisation? A secondary analysis of a randomised controlled trial

et al. 2016

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ObjectivesThe hypothesis that shared decision-making (SDM) reduces medical practice variations is increasingly common, but no evidence is available. We aimed to elaborate further on this, and to perform a first exploratory analysis to examine this hypothesis. This analysis, based on a limited data set, examined how SDM is associated with variation in the choice of single embryo transfer (SET) or double embryo transfer (DET) after in vitro fertilisation (IVF). We examined variation between and within hospitals.DesignA secondary analysis of a randomised controlled trial.Setting5 hospitals in the Netherlands.Participants222 couples (woman aged <40 years) on a waiting list for a first IVF cycle, who could choose between SET and DET (ie, ≥2 embryos available).InterventionSDM via a multifaceted strategy aimed to empower couples in deciding how many embryos should be transferred. The strategy consisted of decision aid, support of IVF nurse and the offer of reimbursement for an extra treatment cycle. Control group received standard IVF care.Outcome measureDifference in variation due to SDM in the choice of SET or DET, both between and within hospitals.ResultsThere was large variation in the choice of SET or DET between hospitals in the control group. Lower variation between hospitals was observed in the group with SDM. Within most hospitals, variation in the choice of SET or DET appeared to increase due to SDM. Variation particularly increased in hospitals where mainly DET was chosen in the control group.ConclusionsAlthough based on a limited data set, our study gives a first insight that including patients’ preferences through SDM results in less variation between hospitals, and indicates another pattern of variation within hospitals. Variation that results from patient preferences could be potentially named the informed patient rate. Our results provide the starting point for further research.Trial registration numberNCT00315029; Post-results.

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Sociological Model for Understanding Medical Practice Variations

Cited by 8 publications

References 46 publications

The impact of new evidence on regional variation in paediatric tonsillectomy and adenoidectomy: a historical review

The impact of new evidence on regional variation in paediatric tonsillectomy and adenoidectomy: a historical review

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

Does a strategy to promote shared decision-making reduce medical practice variation in the choice of either single or double embryo transfer after in vitro fertilisation? A secondary analysis of a randomised controlled trial

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