Unwarranted variations in healthcare delivery: implications for academic medical centres

Wennberg, John E.

doi:10.1136/bmj.325.7370.961

Cited by 659 publications

(535 citation statements)

References 10 publications

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“…Even if several approaches to a specific situation are individually equivalent in terms of patient outcome, choosing 1 of these approaches and implementing it the same way every time will yield results superior to those achieved by random use of various individually valid protocols. 4,28,29 A successful checklist does not have to be based on a proven best practice (such as multiple randomized clinical trials) when the existence of such a proven best practice is not present. Rather, developers simply need to select one approach that is as good as any others, and then assure that it is used consistently and uniformly by all team members.…”

Section: The Checklists Developed By the Us Airmentioning

confidence: 99%

How to develop an effective obstetric checklist

Fausett

Propst

Doren

et al. 2011

American Journal of Obstetrics and Gynecology

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Section: The Checklists Developed By the Us Airmentioning

confidence: 99%

How to develop an effective obstetric checklist

Fausett

Propst

Doren

et al. 2011

American Journal of Obstetrics and Gynecology

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“…This is particularly crucial when the treatment decision confronting the patient is a preference sensitive decision. [1,2] In these types of decisions, there is not a medically dominant treatment, and the "best" treatment depends on the patient's perceptions of the risks and benefits of treatment. During consultation with patients about these decisions, physicians must consider whether or not to provide their patients with comparative risk information.…”

Section: Introductionmentioning

confidence: 99%

“If I’m better than average, then I’m ok?”: Comparative information influences beliefs about risk and benefits

Fagerlin

Zikmund‐Fisher

Ubel

2007

Patient Education and Counseling

104

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Objective-To test whether providing comparative risk information changes risk perceptions.Methods-249 female visitors to a hospital cafeteria were randomized to one of two conditions which differed in whether their hypothetical breast cancer risks was lower or higher than the average woman's. Participants read a scenario describing a breast cancer prevention pill and indicated their: 1) likelihood of taking the pill, and 2) perception of whether the pill provides breast cancer risk reduction.Results-Compared to "below average" women, women told that their hypothetical risk of breast cancer was above average were more likely to endorse taking the pill (2.79 vs. 2.23, F = 4.95, p=0.002) and more likely to believe that the pill provided a significant risk reduction in breast cancer (3.15 vs. 2.73, F = 4.32, p=0.005), even though the risks were equivalent.Conclusions-Providing people with comparative risk information changes their risk perceptions. People who have above average risk may feel compelled to take a treatment because they are at above average risk and therefore may not thoroughly consider the trade-offs in the risks and benefits of treatment.Practice Implications-Physicians and decision aid developers must reconsider the practice of communicating "average risk" information to patients.

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“…These observations have motivated policy makers and some clinicians to suggest that surgeons are not uniformly adhering to treatment standards. 2,6,8,9,11 Although surgeons have enormous influence on decisions about local therapy for breast carcinoma, 10,[12][13][14][15][16] , our understanding of surgeons' knowledge and attitudes toward treatment options is limited. Previous studies have been limited by small samples, low response rates, a focus on a single treatment issue (e.g., reconstruction after mastectomy), or the use of non-U.S. samples.…”

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confidence: 99%

Surgeon perspectives about local therapy for breast carcinoma

Katz

Lantz

Janz

et al. 2005

Cancer

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BACKGROUNDGeographic variations in the use of mastectomy and the use of radiation therapy (RT) after breast‐conserving surgery (BCS) have motivated concerns that surgeons are not uniformly adhering to treatment standards.METHODSThe authors surveyed attending surgeons of a population‐based sample of patients with breast carcinoma diagnosed in Detroit and Los Angeles from December 2001 to January 2003 (n = 365; response rate, 80.0%). Clinical scenarios were used to evaluate opinions about local therapy.RESULTSOn average, surgeons reported that they devoted 31.3% of their total practice to breast carcinoma. Approximately one‐half of surgeons practiced in a community hospital setting, whereas 18.8% practiced in a cancer center. Compared to low volume surgeons, high volume surgeons were more likely to favor BCS with RT for invasive breast carcinoma (60.8%, 74.0%, and 87.2% for low, moderate, and high volume surgeons, respectively, P < 0.001). Surgeons who favored BCS were more likely to perceive greater quality of life (QOL) benefits for BCS than mastectomy (85.9%) compared with surgeons who favored mastectomy (28.6%) and those who did not favor 1 procedure over the other (60.0%, P < 0.001). In a ductal carcinoma in situ scenario, 35.0% of surgeons favored BCS without RT and 61.0% favored BCS with RT. Opinions regarding the role of RT after BCS varied by geographic site, surgeon volume, and patient age.CONCLUSIONSVariation in surgeon opinion concerning local therapy reflected clinical uncertainty about the benefits of alternative treatments. High volume surgeons more frequently endorsed current clinical guidelines that favor BCS compared with mastectomy. This may partly be explained by the greater belief that BCS confers a better patient QOL than mastectomy. Cancer 2005. © 2005 American Cancer Society.

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Unwarranted variations in healthcare delivery: implications for academic medical centres

Cited by 659 publications

References 10 publications

How to develop an effective obstetric checklist

How to develop an effective obstetric checklist

“If I’m better than average, then I’m ok?”: Comparative information influences beliefs about risk and benefits

Surgeon perspectives about local therapy for breast carcinoma

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