This is a presentation by Soraya Ghebleh that discusses some of the main points in unwarranted variation in healthcare and strategies that can potentially reduce it.

1. Unwarranted
Variation
in
Healthcare
Delivery
Soraya
Ghebleh
The
Dartmouth
Institute
for
Health
Policy
and
Clinical
Practice

2. Unwarranted
variation
refers
to
differences
in
the
practice
of
medicine
that
cannot
be
explained
by
illness,
medical
need,
or
evidence-­‐
based
medicine.
Definition

3. * Effective
Care
* Preference-­‐Sensitive
Care
* Supply-­‐Sensitive
Care
Three
Main
Causes

4. Interventions
for
which
benefits
far
outweigh
the
risks
and
the
right
rate
of
treatment
is
for
every
patient
that
meets
clinical
guidelines
to
be
in
need.
Effective
Care

5. When
given
two
equally
viable
treatment
options,
the
patient
must
make
a
decision
about
their
treatment
and
the
correct
rate
of
use
should
depend
on
patient
choice.
Preference-­‐Sensitive
Care

6. Refers
to
capacity
determining
the
amount
of
treatment
a
patient
receives
rather
than
whether
the
treatment
is
necessary
for
a
better
patient
outcome.
Supply-­‐Sensitive
Care

7. Regions
with
higher
use
DO
NOT
demonstrate
better
outcomes
overall.

8. Unwarranted
variation
is
one
of
the
drivers
of
excessive
waste
in
the
healthcare
system.

9. It
contributes
to
wide
differences
in
the
quality
of
care
and
disparities
in
health
outcomes
across
clinical
settings.

10. * Shared-­‐decision
making
* Re-­‐aligning
financial
incentives
with
value-­‐based
care
* Improving
health
outcomes
research
and
disseminating
information
accordingly
to
providers
Strategies
to
Reduce
Unwarranted
Variation

11. * Addresses
preference-­‐sensitive
care
by
providing
the
means
for
patients
to
understand
the
implications
of
decisions
about
healthcare
* Increases
patient
education
*
Involves
the
patient
in
the
decision
* Helps
patients
ask
the
right
questions
about
how
to
proceed
with
care
Shared-­‐Decision
Making

12. * Under
fee-­‐for-­‐service
model
of
reimbursement,
physicians
are
rewarded
for
volume-­‐based
care
* Key
driver
in
supply-­‐sensitive
care
* Introduce
new
payment
models
that
can
reduce
utilization
and
provide
and
reward
care
based
on
value
and
need
rather
than
quantity
* Shift
from
the
“more
is
necessarily
better”
attitude
in
healthcare
delivery
Re-­‐aligning
Financial
Incentives

13. * Many
providers
are
unaware
that
their
outcomes
differ
from
other
providers,
even
within
their
own
institutions
* Development
of
strong,
evidence-­‐based
outcomes
data
is
essential
in
determining
what
is
effective
and
necessary
care
* Creation
of
national
registries
* Sharing
more
data
* Partner
with
providers
to
create
more
transparency
in
outcomes
Health
Outcomes
Research

14. * This
information
is
based
on
research
done
by
Dr.
Jack
Wennberg
and
colleagues
at
The
Dartmouth
Institute
for
Health
Policy
and
Clinical
Practice
* Read
More:
* http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1124450/
* http://www.dartmouth-­‐hitchcock.org/dhmc-­‐internet-­‐
upload/file_collection/Wennberg%20JE%20-­‐%20Practice
%20Variations.pdf
Source