A scoping review of medical practice variation research within the informatics literature

Abstract

Rationale: We performed a scoping review of informatics core literature about medical practice variation (MPV) as an agile summary of the subject in our field.

Materials and methods: The Ovid integrated database was searched between 1946 and 2022 to identify MPV studies published in major informatics journals and conference proceedings. Two reviewers performed relevance screening, with assistance from another independent reviewer for adjudication. The included articles were then thematically analyzed and summarized through discussion among all three reviewers.

Results: A total of 43 articles were included and went through the thematic analysis. About half (n = 21) of the included articles were published in conference proceedings. Five articles reported the effect of MPV on patient outcomes. The variation of interest was most frequently in treatment decisions. In terms of the role informatics played (multiple roles allowed), 39 (90.7%) articles pertained to detection of MPV, 5 were about prevention of MPV and 4 about learning from MPV.

Discussion: MPV remains a critical issue in health care, yet most informatics research has been focused on simple tasks such as automating the detection of MPV and assessing compliance to decision-support systems, and less focused on addressing the causes of variation or supporting learning from variation.

Conclusion: Our scoping review found that informatics studies have focused on detecting of MPV, especially variability in treatments and deviation from practice guidelines. Technological advances should promote more informatics research focused on explaining and learning from MPV.

Keywords: Clinical practice patterns; Guideline adherence; Medical informatics; Professional practice gaps; Review.

Fig. 1.

Article screening process and the intermediate counts.

Fig. 2.

Journal or conference of the publication (N = 43). AMIA: Proceedings of the AMIA Annual Symposium, Medinfo: Proceedings of the Medinfo (Studies in Health Technology & Informatics), IJMI: International Journal of Medical Informatics, JBI: Journal of Biomedical Informatics, MIDM: BMC Medical Informatics & Decision Making, JAMIA: Journal of the American Medical Informatics Association, IPC: Informatics in Primary Care, PNAS: Proceedings of the National Academy of Sciences of the United States of America, ACI: Applied Clinical Informatics, MIIM: Medical Informatics & the Internet in Medicine, JMIR: Journal of Medical Internet Research.

Fig. 3.

Clinical tasks involved in the informatics MPV studies. Note that one study can deal with multiple clinical tasks; see Appendix C for the exact clinical task(s) that each study covered. N/A = not applicable.

Fig. 4.

Roles that informatics played in studying MPV. Note that in one study informatics can serve multiple roles; see Appendix C for details. N/A = not applicable.