Associations Among Practice Variation, Clinician Characteristics, and Care Algorithm Usage: A Multispecialty Vignette Study

David Allan Cook, V. Shane Pankratz, Laurie J. Pencille, Denise M. Dupras, Jane A. Linderbaum, John M. Wilkinson

Research output: Contribution to journalArticle


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 languageEnglish (US)
JournalAmerican Journal of Medical Quality
StatePublished - Jan 1 2019



  • clinical algorithms
  • clinical decision-support systems
  • critical pathways
  • guideline adherence
  • practice guidelines as topic
  • practice variation

ASJC Scopus subject areas

  • Health Policy

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