Let’s get it together!Exploring variation in clinical practice         Kishore Visvanathan, MD FRCSC   Clinical Professor,...
Variation = Loss of confidence
Get your act together!• Office manager• Nurses• Cancer clinic pharmacist
Variation = Confusion
Average patient recall rate (%) May - August 200830.0025.0020.0015.0010.00 5.00 0.00        C    D       I        F       ...
Variation = Waste
Dartmouth Atlas - Variation in Care Delivery
TURP for enlarged prostate• 9.5 per 1,000 males  – Idaho Falls, Idaho• 1.7 per 1,000 Medicare beneficiaries  – Terre Haute...
Surgery for prostate cancer• 3.8 per 1,000 men over 65  – San Luis Obispo, California• 0.3 per 1,000 men over 65  – Albany...
Prostate cancer surgery                 2X
Tu, J. et al, CMAJ Feb 7, 2012
Variation = Inappropriate care (?)
Reduce Variation
Sources of variation   System   Provider   Disease process   Patient preference
Average patient recall rate (%) May - August 200830.0025.0020.0015.0010.00 5.00 0.00        C    D       I        F       ...
Sooner, Safer, Smarter
Prostate cancer surgery                 2X
Variation is a  symptom,not the disease
Plenary Speaker:  K Visvanathan - BC Health Summit 2012: Variation in Clinical Practice
Plenary Speaker:  K Visvanathan - BC Health Summit 2012: Variation in Clinical Practice
Plenary Speaker:  K Visvanathan - BC Health Summit 2012: Variation in Clinical Practice
Plenary Speaker:  K Visvanathan - BC Health Summit 2012: Variation in Clinical Practice
Plenary Speaker:  K Visvanathan - BC Health Summit 2012: Variation in Clinical Practice
Plenary Speaker:  K Visvanathan - BC Health Summit 2012: Variation in Clinical Practice
Plenary Speaker:  K Visvanathan - BC Health Summit 2012: Variation in Clinical Practice
Plenary Speaker:  K Visvanathan - BC Health Summit 2012: Variation in Clinical Practice
Plenary Speaker:  K Visvanathan - BC Health Summit 2012: Variation in Clinical Practice
Plenary Speaker:  K Visvanathan - BC Health Summit 2012: Variation in Clinical Practice
Plenary Speaker:  K Visvanathan - BC Health Summit 2012: Variation in Clinical Practice
Plenary Speaker:  K Visvanathan - BC Health Summit 2012: Variation in Clinical Practice
Plenary Speaker:  K Visvanathan - BC Health Summit 2012: Variation in Clinical Practice
Plenary Speaker:  K Visvanathan - BC Health Summit 2012: Variation in Clinical Practice
Plenary Speaker:  K Visvanathan - BC Health Summit 2012: Variation in Clinical Practice
Plenary Speaker:  K Visvanathan - BC Health Summit 2012: Variation in Clinical Practice
Plenary Speaker:  K Visvanathan - BC Health Summit 2012: Variation in Clinical Practice
Plenary Speaker:  K Visvanathan - BC Health Summit 2012: Variation in Clinical Practice
Plenary Speaker:  K Visvanathan - BC Health Summit 2012: Variation in Clinical Practice
Plenary Speaker:  K Visvanathan - BC Health Summit 2012: Variation in Clinical Practice
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Plenary Speaker: K Visvanathan - BC Health Summit 2012: Variation in Clinical Practice

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  • Shows the graphic product of the Dartmouth project
  • OK, one more prostate example: surgery for prostate cancer. That’s not a minor procedure. Men must be paying attention to the decision to have surgery. Especially when it carries the risk of incontinence and impotence. Response: Yes, this appears to be a very significant difference. And the likely explanation is practice patterns in the USA. There may not be enough urologists in Georgia and the population is underserviced. I will also admit that this operation pays the surgeon very well in a private practice setting. That may be a factor in the US. I can assure you that you wouldn’t see such a variation in Canada… (wait for it!)
  • Variation in rates of PCI:CABG in selected Ontario hospitals
  • Plenary Speaker: K Visvanathan - BC Health Summit 2012: Variation in Clinical Practice

    1. 1. Let’s get it together!Exploring variation in clinical practice Kishore Visvanathan, MD FRCSC Clinical Professor, University of Saskatchewan Division Head, Urology, Saskatoon Health Region
    2. 2. Variation = Loss of confidence
    3. 3. Get your act together!• Office manager• Nurses• Cancer clinic pharmacist
    4. 4. Variation = Confusion
    5. 5. Average patient recall rate (%) May - August 200830.0025.0020.0015.0010.00 5.00 0.00 C D I F E B G A H Doctor
    6. 6. Variation = Waste
    7. 7. Dartmouth Atlas - Variation in Care Delivery
    8. 8. TURP for enlarged prostate• 9.5 per 1,000 males – Idaho Falls, Idaho• 1.7 per 1,000 Medicare beneficiaries – Terre Haute, Indiana
    9. 9. Surgery for prostate cancer• 3.8 per 1,000 men over 65 – San Luis Obispo, California• 0.3 per 1,000 men over 65 – Albany, Georgia More than 12X different!
    10. 10. Prostate cancer surgery 2X
    11. 11. Tu, J. et al, CMAJ Feb 7, 2012
    12. 12. Variation = Inappropriate care (?)
    13. 13. Reduce Variation
    14. 14. Sources of variation System Provider Disease process Patient preference
    15. 15. Average patient recall rate (%) May - August 200830.0025.0020.0015.0010.00 5.00 0.00 C D I F E B G A H Doctor
    16. 16. Sooner, Safer, Smarter
    17. 17. Prostate cancer surgery 2X
    18. 18. Variation is a symptom,not the disease

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