Variations in Medical Care among Small Areas

Wennberg, John E.; Gittelsohn, Alan M.

doi:10.1038/scientificamerican0482-120

Cited by 701 publications

(218 citation statements)

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“…When wide variations in hospitalization rates exist, some investigators think that, in general, the variability is primarily attributable to differences in physician practice. 2,7,8 Although it seems likely that at least some proportion of the differences in hospitalization rates for bronchiolitis is attributable to differences in practice styles, no studies have been published on this topic. Furthermore, no studies have specifically explored whether there are differences between the admitting practices of pediatric and general emergency department medical staffs.…”

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confidence: 99%

Differences in Admission Rates of Children With Bronchiolitis by Pediatric and General Emergency Departments

et al. 2002

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ABSTRACT. Objective. It is uncertain whether pediatric and general emergency departments have different admitting practices regarding children with bronchiolitis. The objective of this study was to quantify the differences in admission practices between pediatric and general emergency departments of children with bronchiolitis in 1 North American metropolitan area, controlling for various factors such as clinical severity, comorbid conditions, and socioeconomic status.Design. Retrospective cohort review of emergency department visits from April 1992 to March 1997.Setting. Five emergency departments (1 pediatric and 4 general) serving the Calgary Health Region, which encompasses ϳ850 000 people.Patients. All children residing within the region who visited a regional emergency department and were diagnosed to have bronchiolitis (International Classification of Diseases, Ninth Revision code 466.1, primary or secondary diagnosis).Main Outcome Measure. Population-standardized estimates of admission rates.Results. The medical charts of 3091 children diagnosed to have bronchiolitis during the study period were reviewed. Of this number, 2496 children were evaluated at the pediatric emergency department, and 629 (25%) were admitted. The remaining 595 (19%) were evaluated at the general emergency departments, and 221 (37%) were admitted. Controlling for age, gender, estimated family income based on postal code, medical comorbidity, and clinical severity estimated by presenting respiratory rate and room air oxygen saturation, populationstandardized estimates for admission rates at the pediatric and general emergency departments were 24% (standard error: 1%) and 43% (standard error: 2%), respectively.Conclusion. Children diagnosed to have bronchiolitis at the Calgary Health Region's pediatric emergency department were about half as likely to be admitted to the hospital as children diagnosed at the region's general emergency departments. Pediatrics 2002;110(4). URL: http://www.pediatrics.org/cgi/content/full/110/4/e49; bronchiolitis, hospitalization rates, practice variation, emergency department. ABBREVIATIONS. CHR, Calgary Health Region; International Classification of Diseases, Ninth Revision; CI, confidence interval. B ronchiolitis is an extremely common childhood disease that accounts for a significant proportion of pediatric hospitalizations. 1 Investigators, using the technique of small-area analysis, have found marked variations in hospitalization rates of children with bronchiolitis with reports of up to sixfold differences in rates per 100 000 children. [2][3][4] This degree of variation is not unique to bronchiolitis, in that substantial variations in rates have been documented for a number of surgical procedures and diseases. 5,6 Although controversy exists as to which factors, in general, are most responsible for the variability in medical practices, in most cases differences in health care access and socioeconomic factors account for at least some proportion of the variability. 5,6 Likewise, in the case of b...

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confidence: 99%

Differences in Admission Rates of Children With Bronchiolitis by Pediatric and General Emergency Departments

et al. 2002

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“…Health policy is focused on improving and managing population health, cutting unnecessary cost and waste, and eliminating unnecessary variation in clinical practice. 23 In addition, the shaping of health policy is heavily influenced by politics, which does not have the singular focus of improving health. The highly contentious political discourse surrounding the ACA clearly demonstrates the politicized nature of health policy.…”

Section: Medical Practice and Health Policy: A Collisionmentioning

confidence: 99%

The Pace of Change in Medical Practice and Health Policy: Collision or Coexistence?

Laiteerapong

Huang

2015

J GEN INTERN MED

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Medical practice and health policy are both changing rapidly. While the adopting of changes is not new for physicians, the pace of change in standards of care, marked by advances and reversals, has accelerated over the course of the past decade. A recurring new theme in medical practice has been an emphasis on tailoring treatment plans to individual patients. Physicians have had to simultaneously absorb new processes in the health care system brought about by the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009 and the Affordable Care Act (ACA) in 2010. The ability of physicians to maintain standards of care that focus on individual patients may conflict with changes resulting from new health policies that emphasize population health management. Primary care physicians may be one of the few collective voices capable of identifying areas where population-level health policies conflict with the care of individual patients, and policymakers should include practicing primary care physicians in the form of community boards in order to ensure the development of new health policies that provide sustainable high-value patient care.

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“…A partir de ese momento se multiplicaron los estudios sobre la «variabilidad en la práctica clí-nica», comparando tasas de procedimientos médicos o quirúrgicos y de resultados obtenidos por dichos procedimientos en distintas áreas geográficas o centros sanitarios. Unos años más tarde Wennberg dio un nuevo impulso a este tipo de estudios, resaltando en su «hipótesis de la incertidumbre» cómo el estilo de práctica de los médicos es el primer factor causante de la variabilidad en situaciones en las que no existen criterios de actuación unánimes y claros 2,3 .…”

Section: Introductionunclassified

Variabilidad en la prescripción farmacéutica de atención primaria en Castilla La Mancha durante 2003

Castro

Fernández

et al. 2005

Rev. Esp. Salud Publica

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Variations in Medical Care among Small Areas

Cited by 701 publications

References 0 publications

Differences in Admission Rates of Children With Bronchiolitis by Pediatric and General Emergency Departments

Differences in Admission Rates of Children With Bronchiolitis by Pediatric and General Emergency Departments

The Pace of Change in Medical Practice and Health Policy: Collision or Coexistence?

Variabilidad en la prescripción farmacéutica de atención primaria en Castilla La Mancha durante 2003

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