k. visvanathan - exploring variation in clinical practice
TRANSCRIPT
Let’s get it together!
Exploring variation in clinical practice
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
Variation = Loss of confidenceVariation = Loss of confidence
Get your act together!Get your act together!
Office manager Nurses Cancer clinic pharmacist
Office manager Nurses Cancer clinic pharmacist
Variation = ConfusionVariation = Confusion
Average patient recall rate (%) May - August 2008
0.00
5.00
10.00
15.00
20.00
25.00
30.00
C D I F E B G A H
Doctor
Variation = WasteVariation = Waste
Dartmouth Atlas - Variation in Care Delivery
TURP for enlarged prostateTURP for enlarged prostate
9.5 per 1,000 males Idaho Falls, Idaho
1.7 per 1,000 Medicare beneficiaries Terre Haute, Indiana
9.5 per 1,000 males Idaho Falls, Idaho
1.7 per 1,000 Medicare beneficiaries Terre Haute, Indiana
Surgery for prostate cancerSurgery 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!
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!
Prostate cancer treatment
2 XSurgery vs.
Radiation
Tu, J. et al, CMAJ Feb 7, 2012
Variation = Inappropriate care (?)Variation = Inappropriate care (?)
Reduce VariationReduce Variation^
Unwanted
Sources of variationSources of variation
System
Provider
Disease process
Patient preference
System
Provider
Disease process
Patient preference
Average patient recall rate (%) May - August 2008
0.00
5.00
10.00
15.00
20.00
25.00
30.00
C D I F E B G A H
Doctor
Sooner, Safer, Smarter
Prostate cancer surgery
2 X
Variation is a symptom, not the disease
Variation is a symptom, not the disease
…Variation is a thief.
It robs from processes, products and services the qualities they are
intended to have.
…Variation is a thief.
It robs from processes, products and services the qualities they are
intended to have.
Unintended variation is stealing healthcare blind today.
…recover a bounty in wasted resources that would dwarf the
puny rewards of cost-containment to date.
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
Controlling Variation in Health Care
Donald M. BerwickMedical Care
December 1991, 29(12)pp 1212-25
Controlling Variation in Health Care
Donald M. BerwickMedical Care
December 1991, 29(12)pp 1212-25