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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
Statement of
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
RMID: 0030064826
DOI: 10.1071/AH15101
Appears in Collections:Public Health publications

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