Please use this identifier to cite or link to this item:
https://hdl.handle.net/2440/105642
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Type: | Journal article |
Title: | Screening for important unwarranted variation in clinical practice: a triple-test of processes of care, costs and patient outcomes |
Author: | Partington, A. Chew, D. Ben-Tovim, D. Horsfall, M. Hakendorf, P. Karnon, J. |
Citation: | Australian Health Review, 2017; 41(1):104-110 |
Publisher: | CSIRO Publishing |
Issue Date: | 2017 |
ISSN: | 0156-5788 0159-5709 |
Statement of Responsibility: | Andrew Partington, Derek P. Chew, David Ben-Tovim, Matthew Horsfall, Paul Hakendorf and Jonathan Karnon |
Abstract: | Objective: Unwarranted variation in clinical practice is a target for quality improvement in health care, but there is no consensus on how to identify such variation or to assess the potential value of initiatives to improve quality in these areas. This study illustrates the use of a triple test, namely the comparative analysis of processes of care, costs and outcomes, to identify and assess the burden of unwarranted variation in clinical practice. Methods: Routinely collected hospital and mortality data were linked for patients presenting with symptoms suggestive of acute coronary syndromes at the emergency departments of four public hospitals in South Australia. Multiple regression models analysed variation in re-admissions and mortality at 30 days and 12 months, patient costs and multiple process indicators. Results: After casemix adjustment, an outlier hospital with statistically significantly poorer outcomes and higher costs was identified. Key process indicators included admission patterns, use of invasive diagnostic procedures and length of stay. Performance varied according to patients’ presenting characteristics and time of presentation. Conclusions: The joint analysis of processes, outcomes and costs as alternative measures of performance inform the importance of reducing variation in clinical practice, as well as identifying specific targets for quality improvement along clinical pathways. Such analyses could be undertaken across a wide range of clinical areas to inform the potential value and prioritisation of quality improvement initiatives. |
Keywords: | Humans Patient Readmission Middle Aged Emergency Service, Hospital Hospitals, Public Risk Adjustment South Australia Female Male Acute Coronary Syndrome Quality Improvement Practice Patterns, Physicians' Outcome and Process Assessment, Health Care |
Rights: | Journal compilation © AHHA 2017. Open Access. For any reuse or distribution, you must make clear to others the license terms of this work. The best way to do this is with a link to http://creativecommons.org/licenses/by-nc-nd/3.0/ |
DOI: | 10.1071/AH15101 |
Published version: | http://dx.doi.org/10.1071/ah15101 |
Appears in Collections: | Aurora harvest 8 Public Health publications |
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hdl_105642.pdf | Published version | 383.65 kB | Adobe PDF | View/Open |
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