Variation in outpatient procedure rates in Canadian teaching hospitals

To determine the variation in the rate at which specific procedures are performed on an outpatient basis in Canadian teaching hospitals.

An index of outpatient activity was developed using the ratio of expected-to-actual performance, with the expected performance representing empirical, exogenous criteria.

Canadian teaching hospitals.

The index indicated whether the hospital, or group of hospitals, of interest is equally, more, or less active than the comparison group. The results show that Canadian teaching hospitals were 3% less active than Canadian nonteaching hospitals and Alberta teaching hospitals were 22% less active than all Canadian teaching hospitals. Individual teaching hospitals in Alberta were 21% more, 40% less, 9% less, 44% less, 8% less, 39% less, 20% less, and 2% less active than all other Alberta teaching hospitals.

If variation in the use of less costly treatment modalities represents variation in quality as in Donabedian's unifying model, the results show considerable variation in quality across the generally accepted leaders in the medical care field. By comparing teaching hospitals with other teaching hospitals the difference in the patient severity level is minimized. The decision regarding the delivery modality represents only one decision in the complex decision matrix faced by physicians in the treatment episode. Given the considerable variation demonstrated in this study, the task of developing protocol, standards, or guidelines in order to reduce variation over the total treatment episode will be enormous.