Variation in Clinical Practice: A Priority Setting Approach to the Staged Funding of Quality Improvement
Abstract
Variation in adherence to clinical guidelines, and in the organisation and delivery of health care significantly impact patient outcomes and health service costs. Despite mounting evidence of variation in clinical practice, the funds allocated to improve the quality of existing services remain small, relative to the resources allocated to new technologies. Quality improvement is a complex intervention, with a lack of focus on outcomes, and greater uncertainty around its effects. These factors have contributed to a relatively narrow, mainstream view of quality improvement as focussing on safety, with efforts to improve adherence to best practice limited to high profile clinical areas. This paper presents an analysis of linked, routinely collected data to identify variation in patient outcomes and processes of care across hospitals for patients presenting with low-risk chest pain. Such analyses provide a low cost, broadly applicable approach to identifying potentially important areas of variation in clinical practice, to inform the prioritisation of more detailed analyses to validate, and further investigate the causes of variation.
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There were four further cost-utility analyses that used economic modelling rather than empirical methods, and two cost-consequence analyses.
“There were also four further CUAs that used economic modelling rather than empirical methods [8–10, 34], and two cost-consequence analyses [16, 35].”
From Use of health economic evaluation in the implementation and improvement science fields—a systematic literature review (2019) · cites this paper as [35]
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- Authors
- Karnon, J., Partington, A., Horsfall, M., & Chew, D.
- Affiliations
- The University of Adelaide (AU)
- South Australian Health and Medical Research Institute (AU)
- Flinders University (AU)
- Corresponding author
- Karnon, Jonathan
- Venue
- Applied Health Economics and Health Policy
- Published
- 2015-02-28
- Volume
- 14
- Issue
- 1
- Pages
- 21-27
- ISSN
- 1175-5652 (ISSN-L)
- 1179-1896
- OpenAlex
- W2102056135
- Cited by
- 15
- References
- 26
- Citations by year
- 2025: 1 · 2023: 1 · 2021: 3 · 2020: 1 · 2019: 2 · 2018: 5 · 2017: 1 · 2015: 1
- FWCI
- 4.50
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Applied Health Economics and Health Policy (publishedVersion)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
- Funders
- HCF Research Foundation
- Topics
- Health Sciences › Health Professions › Health Information Management › Healthcare Quality and Management
- Health Sciences › Health Professions › General Health Professions › Healthcare cost, quality, practices
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Keywords
- clinical practice variation, priority setting, clinical guideline adherence, low-risk chest pain, patient outcomes, process of care, hospital variation, administrative data, health care costs, safety
- MeSH terms
- Cardiovascular Diseases, Female, Health Priorities, Humans, Male, Middle Aged, Practice Patterns, Physicians', Health Care Costs, Outcome Assessment, Health Care, Guideline Adherence, Quality Improvement, Healthcare Financing
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