Unwarranted clinical variations and their manifestations are an evolving area of research in the medical field of study. According to Sutherland and Levesque (2019), clinical variations are present across different health care settings, including “diagnosis, treatment, and prescribing practices” (p. 688). This discussion post will consider the framework proposed by Sutherland and Levesque (2019) developed to account for unwarranted clinical variations. In addition, it will be compared to other clinical frameworks.
The proposed framework aims to account for different types of unwarranted clinical variations in a variety of healthcare settings. Such variations can be defined as variations concerning patient care that are “not a direct and proportionate response to available evidence; or to the healthcare needs and informed choices of patients” (Harrison et al., 2020, p. 2). Sutherland and Levesque (2019) offer the model that identifies six main categories pertaining to the perspectives of capacity, evidence, and agency.
Thus, the capacity domain accounts for organizational allocative decisions and technical acumen, while evidence considers observance of guidelines and adoption or deviation from the existing evidence base (Atsma et al., 2020). Meanwhile, the perspective of the agency discusses provider engagement and patient or provider requirements, with the patient needs not being met described as a factor in unwarranted clinical variations (Atsma et al., 2020). Overall, the framework allows encapsulating potential diagnosing, treatment, and prescribing issues that lead to differences in health care processes and outcomes.
The framework is empirically derived and helps delineate the occurrence of unwarranted variations. It differs substantially from some of the frameworks provided by Nash et al. (2019). For example, IHI Breakthrough Series (BTS) Model is a learning framework aimed at hospitals improving performance in a specific clinical or operational area (Nash et al., 2019). Similar to the framework offered by Sutherland and Levesque (2019), the IHI BTS model is based on the collection of data on the existing issues in the health care organization.
However, it also incorporates the procedures for identifying barriers to optimal performance and improving clinical outcomes. Sutherland and Levesque’s framework adds to the IHI BTS by including contextual factors to the model that help determine the organizations’ failures in specific areas. Another system, the FOCUS PDCA framework, affords an approach to process improvement in health care settings. The model differs from Sutherland and Levesque’s structure as it proposes means for improvement, while the framework for unwarranted variants aims to map their origin. Thus, the suggested framework has certain similarities and differences with the existing models currently applied in health care settings.
In my opinion, the framework for identifying unwarranted clinical variations provides a precise measuring instrument. I believe the recognition of the role of the agency of health care organizations in clinical decision-making is imperative for understanding the occurrence of unwarranted variants. The suggested framework can serve as a tool for collecting relevant information for a database to help increase evidence-based and cost-effective clinical decisions (Richards et al., 2019). Overall, if further developed to address the limitation of no focus provided when considering the six categories in the domains of capacity, evidence, and agency, the framework can help identify and reduce unwarranted variations.
In summary, unwarranted clinical variations present a considerable issue in the field of medicine. Examining the reasons behind their occurrence can lead to better health outcomes for patients and cost reduction for health care facilities. The proposed framework aims to identify, quantify, and minimize unwarranted clinical variations in health care settings. It is an effective and valuable tool for investigating reoccurring unwarranted variants. However, it should be further developed to address its existing limitations.
References
Atsma, F., Elwyn, G., & Westert, G. (2020). Understanding unwarranted variation in clinical practice: A focus on network effects, reflective medicine and learning health systems. International Journal for Quality in Health Care, 32(4), 271–274. Web.
Harrison, R., Hinchcliff, R. A., Manias, E., Mears, S., Heslop, D., Walton, V., & Kwedza, R. (2020). Can feedback approaches reduce unwarranted clinical variation? A systematic rapid evidence synthesis. BMC Health Services Research, 20(1), 1–81. Web.
Nash, D. B., Joshi, M. S., Ransom, E. R., & Ransom, S. B. (2019). The healthcare quality book: Vision, strategy, and tools (4th ed.). Health Administration Press.
Richards, J. M., Burgon, T. B., Tamondong-Lachica, D., Bitran, J. D., Liangco, W. L., Paculdo, D. R., & Peabody, J. W. (2019). Reducing unwarranted oncology care variation across a clinically integrated network: A collaborative physician engagement strategy. Journal of Oncology Practice, 15(12), 1076–1084. Web.
Sutherland, K., & Levesque, J. (2019). Unwarranted clinical variation in health care: Definitions and proposal of an analytic framework. Journal of Evaluation in Clinical Practice, 26(3), 687–696. Web.