Practice Variation Epidemic

Practice variation, practice variation, and more practice variation. It doesn't matter where in medicine you look - surgery, primary care, physical therapy, chiropractic, etc. - there is plenty of variability to go around.  The question is 'Why?'. Among other things, the answer is a combination of perverse incentives, ignorance of evidence, and stubborn refusal to follow known evidence. In some cases, variabilty reaosnably exists because evidence can't yet specifically inform decision-making. As the evidence evolves, there will be less tolerance among payors to reward unexplained variability. The answer to our healthcare system's woes is driving unexplained variability out of the system. Will you be a part of the problem or solution?

John

Download Irwin-Spine-2005-PracticeVariationDegenCxSpineSurg.pdf

Download Irwin-Spine-2005-PracticeVariationDegenLxSpineSurg.pdf

Download Sirovich-ArchIntMed-2005-VariationPrimaryCareTreatment.pdf

Comments

[Britt Smith]

Wow, two great postings in less than 24 hrs!!!
I stated a few days ago on the blog my experience recently at a study group with a local orthopaedic group. I find it fascinating the level of practice variation in medicine, which is not limited to PT, orthopods, but spans the whole 'kitten-kabottle' of practitioners. We were discussing the use of post-op pain med, corticosteroid injections etc and the within group variance is very high. There was some agreement on pain meds, but vigorous disagreement on steroid of choice, although the evidence points away from Triamcinalone towards
Depomedrol.
I admire the candid discussion I heard at the meeting and, I believe there was a mood among the physicians to narrow the variance-in-practice.
Each group of practitioners has 'tolerances' for variation, but the professionals, as a group, should agree on general strategies of how to manage a patient. The orthopaedic surgeons are working on this as we speak, but the biases are deep, and, I believe, mostly related to training (what shop you learn your skills in...under what master you learn the trade). WE have much of the same biases, which are almost characterological (mostly stubborness or arrogance) in the individuals, which contribute to ignorance of the evidence (not seeking evidence) and maybe avarice or greed. The influences of why are difficult to discern, the evidence for how to change the persons is still hard to determine....but change we must.
Thanks,
Britt