Associations Among Practice Variation, Clinician Characteristics, and Care Algorithm Usage: A Multispecialty Vignette Study. (November 2019)

• Record Type: Journal Article
• Authors: Cook, David A.; Pankratz, V. Shane; Pencille, Laurie J.; Dupras, Denise M.; Linderbaum, Jane A.; Wilkinson, John M.
• Is Part Of: American journal of medical quality. Volume 34:Number 6(2019)
• Page Start: 596
• Page End: 606
• Publication Date: 2019-11
• Subjects: practice variation -- practice guidelines as topic -- guideline adherence -- clinical algorithms -- critical pathways -- clinical decision-support systems; Medical care -- Quality control -- Periodicals; Medical care -- Evaluation -- Periodicals; Medical care -- Utilization review -- Periodicals; Medical care -- United States -- Periodicals; 362.1
• DOI: 10.1177/1062860618824992
• Languages: English
• ISSNs: 1062-8606

Abstract

The objective was to quantitatively evaluate clinician characteristics associated with unwarranted practice variation, and how clinical care algorithms influence this variation. Participants (142 physicians, 53 nurse practitioners, and 9 physician assistants in family medicine, internal medicine, and cardiology) described their management of 4 clinical vignettes, first based on their own practice (unguided), then using care algorithms (guided). The authors quantitatively estimated variation in management. Cardiologists demonstrated 17% lower variation in unguided responses than generalists (fold-change 0.83 [95% confidence interval (CI) 0.68, 0.97]), and those who agreed that practice variation can realistically be reduced had 16% lower variation than those who did not (fold-change 0.84 [CI, 0.71, 0.99]). A 17% reduction in variation was observed for guided responses compared with baseline (unguided) responses (fold-change 0.83 [CI, 0.76, 0.90]). Differences were otherwise similar across clinician subgroups and attitudes. Unwarranted practice variation was similar across most clinician subgroups. The authors conclude that care algorithms can reduce variation in management.