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Physician Practice Pattern Variations in Common Clinical Scenarios Within 5 US Metropolitan Areas.
Zirui Song1,2, Sneha Kannan2, Robert J Gambrel3
1Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts.
JAMA Health Forum
|August 17, 2022
Summary
Significant physician practice variations exist within US metropolitan areas, impacting quality of care across specialties. Understanding these differences is key to improving healthcare value.
Area of Science:
- Health Services Research
- Clinical Practice Variation
- Healthcare Quality
Background:
- Regional variations in healthcare quality are known, but physician-level practice pattern differences within regions are less understood.
- Notable disparities exist among medical specialists regarding decision-making in common clinical scenarios.
Purpose of the Study:
- To investigate physician-level variations in clinical decision-making within specific geographic areas.
- To analyze practice pattern differences among specialists in common scenarios with established guidelines.
Main Methods:
- A cross-sectional study analyzed 2016-2019 insurance data from 5 metropolitan statistical areas (MSAs).
- Physician performance on 14 quality/appropriateness measures across 7 specialties was assessed using multilevel models.
- Variations were quantified by comparing physician quintiles, adjusted for patient demographics and risk.
Main Results:
- Substantial physician-level practice variations were observed across all 7 specialties and 14 clinical measures.
- Examples include significant differences in statin therapy for coronary artery disease and arthroscopy for osteoarthritis.
- Measure reliability exceeded 70.0% across most measures, indicating consistent physician performance assessment.
Conclusions:
- This study reveals considerable physician-level practice variations within metropolitan areas.
- Identifying the drivers of these variations is crucial for enhancing the value of healthcare delivery.
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