Variations in health care:
The good, the bad and the inexplicable
John Appleby, Veena Raleigh, Francesca Frosini, Gwyn Bevan, Haiyan Gao, Tom Lyscom
The King’s Fund 2011
Available online at: http://bit.ly/emTUBU
As this report illustrates with reference to differences in admission rates for many routine surgical procedures, variations in health care are not limited to relatively rare or new interventions. Nor are such variations a new phenomenon or simply concerned with the efficient use of scarce health service resources. The existence of persistent unwarranted variations in health care directly impacts on equity of access to services, the health outcomes of populations and efficient use of resources. But the eradication of all variation is not the task.
As Al Mulley has noted:
If all variation were bad, solutions would be easy. The difficulty is in reducing the bad variation, which reflects the limits of professional knowledge and failures in its application, while preserving the good variation that makes care patient centred.
When we fail, we provide services to patients who don’t need or wouldn’t choose them while we withhold the same services from people who do or would, generally making far more costly errors of overuse than of underuse.
The task, then, is more complicated. However, the NHS is well placed in terms of the data it collects to begin to map out in a systematic way where variations exist and then to move forward with strategies to tackle them. A key focus will need to be to tackle clinical decisions through greater emphasis on shared decision-making…”
1 Variations: what’s good, what’s bad?
Measuring variation and adjusting for need
2 Variations in elective hospital admissions
Ubiquity: variation in common, clinically effective procedures
Persistence: trends in variation
Efficiency: variation in day case rates
Effectiveness: variation in low effectiveness procedures
Equity: variation in pre-operative health
Choice: preference-sensitive variations
3 Conclusions and recommendations
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