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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.
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Soraya Ghebleh
UNWARRANTED VARIATION IN HEALTHCARE DELIVERY
Unwarranted variation refers to differences in the practice of
medicine that cannot be explained by illness, medical
need, or evidence-based medicine.
DEFINITION
¡ Effective Care ¡ Preference-Sensitive Care ¡ Supply-Sensitive Care
THREE MAIN CAUSES
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
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
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
Regions with higher use DO NOT
demonstrate better outcomes overall.
Unwarranted variation is one of the drivers of excessive waste in the
healthcare system.
It contributes to wide differences in the quality of
care and disparities in health outcomes across
clinical settings.
¡ 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
¡ 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
¡ 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
¡ 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
¡ 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
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