K. Visvanathan - Exploring 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

K. Visvanathan - Exploring Variation in Clinical Practice Presentation Transcript

  • 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. Variation = Loss of confidence
  • 3. Get your act together! Office manager Nurses Cancer clinic pharmacist
  • 4. Variation = Confusion
  • 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. Variation = Waste
  • 7. Dartmouth Atlas - Variation in Care Delivery
  • 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. 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. Prostate cancer treatment 2X Surgery vs. Radiation
  • 11. Tu, J. et al, CMAJ Feb 7, 2012
  • 12. Variation = Inappropriate care (?)
  • 13. Reduce Variation ^ Un wan ted
  • 14. Sources of variationSystemProviderDisease processPatient preference
  • 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. Sooner, Safer, Smarter
  • 17. Prostate cancer surgery 2X
  • 18. Variation is a symptom, not the disease
  • 19. …Variation is a thief. It robs from processes, productsand services the qualities they are intended to have.
  • 20. Unintended variation is stealing healthcare blind today. …recover a bounty in wasted resources that would dwarf the puny rewards of cost- containment to date. Berwick, 1991
  • 21. Controlling Variation in Health Care Donald M. Berwick Medical CareDecember 1991, 29(12) pp 1212-25