Identifying and acting on potentially inappropriate care
Identifying when the wrong treatments are chosen, and putting a stop to it, is an important way to improve the quality of health care. There are many ways to do this. Strategies include using clinical guidelines or decision support systems, clinician education, clinical engagement, peer review, and adjusting the pricing, funding and availability of individual treatments. All of these methods can be useful. But there are currently few concerted efforts to evaluate and benchmark treatment choices at the hospital level, and to use this information to drive improvement.
Inappropriate care is a longstanding concern in health policy. For over 40 years, small-area analyses have shown significant geographic variation in the rates at which different subpopulations are given common surgical procedures. 1,2 The Organisation for Economic Co-operation and Development has recently published this kind of analysis, including a chapter on Australia showing the rates of nine types of hospital admission in different Medicare Local areas, adjusted for age and sex.3 A more detailed atlas of variation and supporting studies has also been published by the Australian Commission on Safety and Quality in Health Care.4
Wide variation in practice patterns has been attributed to clinicians interpreting evidence…