Medical practice variation in Vietnam: a cross-sectional study

Area of Science:

• Healthcare quality assessment
• Clinical decision-making analysis
• Health economics

Background:

• Clinical care variation is a global concern linked to adverse health outcomes.
• This study assessed provider decision-making and financial waste from unnecessary tests in Vietnam.
• Focus areas included obstetrics and cardiology within a private health system.

Purpose of the Study:

• To evaluate clinical decision-making among obstetric and cardiac providers in Vietnam.
• To quantify financial waste attributed to unnecessary laboratory and imaging tests.
• To demonstrate the utility of the E-Patient Quality Improvement and Standardization (EQIS) platform.

Main Methods:

• A cross-sectional study involving 216 obstetric and 71 cardiac providers across seven Vietnamese hospitals.
• Participants completed three simulated e-patient cases on the EQIS platform.
• Unnecessary tests and associated costs were estimated based on deviations from evidence-based recommendations.

Main Results:

• Substantial variation in clinical practice quality was observed, with mean scores of 73.5% for obstetrics and 80.0% for cardiology.
• Diagnostic performance showed the lowest scores and highest variability across both specialties.
• Providers ordered 2.4-2.9 unnecessary tests per case, resulting in estimated monthly excess costs of 330-495 million VND.

Conclusions:

• Significant variation in clinical quality and prevalent unnecessary testing were found in Vietnamese obstetric and cardiac care.
• The EQIS platform effectively assessed clinical practice patterns and estimated associated financial waste.
• Findings highlight the need for quality improvement initiatives in these clinical areas.