Inconsistent care practices adversely affect outcomes, patient safety, performance measures and cost. Care teams rely on advanced clinical practices to reduce care variability and ensure they’re providing clinically effective care.
Clinical healthcare variation has been a topic of discussion and analysis since the early 1970s, when studies started highlighting geographic differences in cost and outcomes. Despite the widespread acknowledgement of care variations, current studies still report these inconsistencies, with costs estimated at between 14-16% of total healthcare spend in the United States. What has changed in the intervening 40 years? We now have the know-how, technology, and the sense of urgency to reduce variability and work toward standardization of care.
So, if the evidence of waste is proven, and we have the knowledge to address it, why haven’t we made further strides to achieve clinical effectiveness?
Clinical variations in focus
In the years since that first report, clinical research has identified both the causes and costs of care variations, along with potential health solutions that can improve quality and eliminate clinical waste. A pivotal piece of research, Eliminating Waste in US Health Care, by Donald M. Berwick, MD, MPP and Andrew D. Hackbarth, MPhil, revealed that waste in clinical care occurs when: (1) patients fall through the cracks in a fragmented system; (2) they are subjected to care that, according to evidence and the patients' own preferences, cannot help them; and (3) the clinical choices that patients and providers sometimes make aren't justified by available knowledge and experience.
In fact, unproven treatments amount to trillions of dollars globally, stretching health systems already strained beyond their limits. Although it’s been widely accepted that evidence-based care is crucial, it’s equally important that healthcare organizations make required changes systemically – that is, across care teams and care settings – in order to change deeply-rooted behaviors. Not only among the clinical staff, but among patients themselves who have a role to play in understanding their care choices.
Understanding variations
Take the example of an older American man who has been diagnosed with early-stage prostate cancer. Cancer of the prostate gland is a common disease that is associated with aging. While most prostate cancer is slow-growing and not likely to cause harm, some men will develop aggressive disease that causes death. Estimates vary, but a typical assessment is that one out of ten men has the disease in some form by age fifty. What’s not so “typical” is the treatment. The man has up to four times higher likelihood of having his prostate surgically removed in some regions of the United States than in others, where watchful waiting might be recommended. Yet, clinical research shows that outcomes for the two approaches would be the same.
The care patients receive should not vary based on the healthcare system, where they reside or the doctor they see. When there are choices available and a clinician knows which approach optimizes outcomes, the treatment plan should not be a matter of chance. The goal is achievable. It’s already being accomplished. But a challenge lies in bringing scale to those efforts so that clinicians and patients can optimize their decisions.
