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.
| Original language | English (US) |
|---|---|
| Journal | American Journal of Medical Quality |
| DOIs | |
| State | Published - Jan 1 2019 |
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Keywords
- clinical algorithms
- clinical decision-support systems
- critical pathways
- guideline adherence
- practice guidelines as topic
- practice variation
ASJC Scopus subject areas
- Health Policy
Cite this
Associations Among Practice Variation, Clinician Characteristics, and Care Algorithm Usage : A Multispecialty Vignette Study. / Cook, David Allan; Pankratz, V. Shane; Pencille, Laurie J.; Dupras, Denise M.; Linderbaum, Jane A.; Wilkinson, John M.
In: American Journal of Medical Quality, 01.01.2019.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Associations Among Practice Variation, Clinician Characteristics, and Care Algorithm Usage
T2 - A Multispecialty Vignette Study
AU - Cook, David Allan
AU - Pankratz, V. Shane
AU - Pencille, Laurie J.
AU - Dupras, Denise M.
AU - Linderbaum, Jane A.
AU - Wilkinson, John M.
PY - 2019/1/1
Y1 - 2019/1/1
N2 - 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.
AB - 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.
KW - clinical algorithms
KW - clinical decision-support systems
KW - critical pathways
KW - guideline adherence
KW - practice guidelines as topic
KW - practice variation
UR - http://www.scopus.com/inward/record.url?scp=85060920425&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85060920425&partnerID=8YFLogxK
U2 - 10.1177/1062860618824992
DO - 10.1177/1062860618824992
M3 - Article
AN - SCOPUS:85060920425
JO - American Journal of Medical Quality
JF - American Journal of Medical Quality
SN - 1062-8606
ER -