Variation in Medical Practice and Implications for Quality Scope and Use of Variation in Healthcare

Healthcare quality researchers use a variety of categories to measure improvements and detect variation in quality of care. Quality in healthcare is measured by its ability to satisfy qualitative standards as well as quantitative thresholds. Institute of medicine (IMO) has established six aims for healthcare improvement to ensure that medical care is safe, timely, effective, efficient, equitable, and patient-centered. As such, clinical indicators that address the timeliness of care, for example, from several clinical domains- Acute myocardial infarction, surgical infection prevention, and community-acquired pneumonia are aggregated to assess the appropriate level of time-dependent quality of care at a medical facility.

Variability plays an obvious role in identifying, measuring, and reporting these quality indicators and process of care improvements. For example, the patient mix may make it difficult to compare the process of care measures across multiple hospitals in the same system, creating the appearance of variation among facilities’ services.

Consequently, some healthcare managers are reluctant to use quality improvement measures and indicators because they perceive them as biased toward academic medical research centers or large healthcare organizations, which are seen as not subject to broad variation.

This assumption is unfortunate and false because quality improvement efforts can be and have been successfully applied to small organizations and practices, including single physician practices.