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Small Area Analysis And The Challenge Of Practice Variation

J. Wennberg, K. Mcpherson, D. Goodman
Published 2015 · Psychology

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The study of variations has challenged long-standing theories that the utilization of medical services is primarily determined by the incidence of illness, the constraints of medical science, or patient preferences. This chapter traces the development of empirical research in small area variation in the United States, England, and other countries and the concurrent evolution of explanatory theories. Variations in health services are marked across every level of care – small areas, tertiary regions, and health care providers. The majority of this variation is not explained by patient differences. We categorize different sources of variation into (1) effective care, where benefits far exceed harm, (2) preference-sensitive care, where there are a variety of options for patients, each with benefits and trade-offs, and (3) supply-sensitive care, where varying supplies of health care resources lead to differences in the frequency of care, with scant evidence that more services benefit patients. Each of these explanatory categories is linked to specific clinical and policy remedies that, if implemented, would significantly improve health care.
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