Medical practice variation in Vietnam: a cross-sectional study

Variation in clinical care is a recognized global issue and has been associated with poor health outcomes. This study describes the use of the E-Patient Quality Improvement and Standardization (EQIS) platform to assess provider clinical decision-making and to estimate financial waste from unnecessary laboratory and imaging tests in two clinical areas-obstetrics and cardiology-in Vietnam.

This cross-sectional study included maternal and cardiac health clinicians across all seven hospitals within a private health system in Vietnam. A total of 216 obstetric providers and 71 cardiac care providers participated. Each participant was randomly assigned three simulated e-patient cases relevant to their specialty on the EQIS platform. Overall scores were calculated as the percentage of correct responses for each participant. The number of unnecessary tests and their associated costs were estimated for each case.

Overall, practice quality varied substantially, with mean scores of 73.5 (9.2), 95%CI: 72.3-74.7 for obstetric cases and 80.0 (7.5), 95% CI: 79.6-82.1 for cardiac cases. Across domains, diagnostic performance had the lowest mean score (< 70%) and the greatest variability (SD: 19.0-19.9). Mean scores also varied by provider type, educational level, department, average daily patient volume, hospital, age, and years of experience. Relative to evidence-based recommendations, providers ordered 2.4-2.9 unnecessary tests per case. These patterns were associated with estimated excess costs of 330 to 495 million VND per month for the hospital system.

Clinical quality varied substantially, and unnecessary testing was common in both obstetric and cardiac care across the seven private hospitals included in this study in Vietnam. The EQIS platform may be a useful tool for assessing clinical practice patterns and estimating unnecessary costs.