Variation in clinical practice: forests and trees revisited

Christopher J D Wallis; C David Naylor; Allan S Detsky

doi:10.1038/nrurol.2017.102

Variation in clinical practice: forests and trees revisited

Nat Rev Urol. 2017 Sep;14(9):511-512. doi: 10.1038/nrurol.2017.102. Epub 2017 Jun 27.

Authors

Christopher J D Wallis^{1

2

3}, C David Naylor^{1

4}, Allan S Detsky^{1

4

5}

Affiliations

¹ Institute of Health Policy, Management &Evaluation, University of Toronto, 155 College Street, Toronto, Ontario M5T M36, Canada.
² Department of Surgery, University of Toronto, 149 College Street, Toronto, Ontario M5T 1P5, Canada.
³ Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Suite A305a, Toronto, Ontario M4N 3M5, Canada.
⁴ Department of Medicine, University of Toronto, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada.
⁵ Department of Medicine, Mount Sinai Hospital and University Health Network, 600 University Ave, Room 429, Toronto, Ontario M5G 1X5, Canada.

PMID: 28654091
DOI: 10.1038/nrurol.2017.102

Abstract

Variations in clinical practice are commonly viewed as a sign of uneven quality of care and attributed to provider self-interest. However, patient preferences, physician practice patterns, and diagnostic and therapeutic uncertainty also cause variations. Greater attention to both doctor-patient interactions and limits to the available evidence might enable more effective assessment and improvement of health-care quality.

MeSH terms

Healthcare Disparities / standards*
Humans
Physician-Patient Relations*
Practice Guidelines as Topic
Practice Patterns, Physicians' / standards*
Quality Assurance, Health Care / methods*
Quality Improvement*
Uncertainty*