Medical practice variation: public reporting a first necessary step to spark change

Abstract

From previous work, we know that medical practice varies widely, and that unwarranted variation signals low value for patients and society. We also know that public reporting helps to create awareness of the need for quality improvement. Despite the availability of rich data, most Western countries have no routine surveillance of the geographic distribution of utilization, costs, and outcomes of healthcare, including trends in variation over time. This paper highlights the role of transparent public reporting as a necessary first step to spark change and reduce unwarranted variation. Two recent examples of public reporting are presented to illustrate possible ways to reduce unwarranted variation and improve care. We conclude by introducing the Value Improvement Cycle, which underscores that reporting is only a necessary first step, and suggests a path toward developing a multi-stakeholder approach to change.

Figure 1

(a) Trends in age and sex adjusted number of herniated disc surgeries per 100 000 persons, 2011–2014, The Netherlands. (b) Observed volumes of individual hospitals with high and low volume of herniated disc surgeries, 2011–2014, The Netherlands.

Figure 2

(a) Strong opiod dispensing rates; total by year, rate by 1000, 2011–2015, New Zealand (red line = national average). (b) People dispensed oxycodone; total by year, rate by 1000, 2011–2015, New Zealand (red line = national average).

Figure 3

The Value Improvement Cycle. How to reduce unwarranted variation?