Clinical variation: why it matters

Duggan, Anne; Koff, Elizabeth; Marshall, Villis R.

doi:10.5694/mja16.00819

Cited by 21 publications

(24 citation statements)

References 9 publications

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“…Despite this, considerable variation in the approach to management, including empiric antibiotic choice and duration, risk stratification and treatment location, is described . Although some differences in practice are due to geography and local microbiology, unwarranted variation can lead to incorrect prescribing, poor patient outcomes and increased health‐care expenditures …”

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confidence: 99%

Management of fever and neutropenia in children with cancer: A survey of Australian and New Zealand practice

Haeusler

Slavin

Bryant

et al. 2018

J Paediatrics Child Health

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confidence: 99%

Management of fever and neutropenia in children with cancer: A survey of Australian and New Zealand practice

Haeusler

Slavin

Bryant

et al. 2018

J Paediatrics Child Health

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“…The “ Better cardiac care for Aboriginal and Torres Strait Islander people ” strategy has increased attention on capturing CVRA data on a broad scale, initiating its introduction to the nKPI dataset ( 26 ) (although the age criteria begins at 35 years, some 10 years older than clients documented with elevated risk in the NT). A routine data source allows the assessment of “unwarranted” variation in the delivery of key service items, a necessary first step to examine potential health system factors that when leveraged, may enhance consistent, appropriate care on a broad-scale ( 27 , 28 ). We demonstrate the value of CQI processes in systematically capturing, reporting and reviewing data on the variation in CVRA and follow-up.…”

Section: Discussionmentioning

confidence: 99%

Integrated Clinical Decision Support Systems Promote Absolute Cardiovascular Risk Assessment: An Important Primary Prevention Measure in Aboriginal and Torres Strait Islander Primary Health Care

Matthews

Burgess

Connors

et al. 2017

Front. Public Health

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BackgroundAboriginal and Torres Strait Islander Australians experience a greater burden of disease compared to non-Indigenous Australians. Around one-fifth of the health disparity is caused by cardiovascular disease (CVD). Despite the importance of absolute cardiovascular risk assessment (CVRA) as a screening and early intervention tool, few studies have reported its use within the Australian Indigenous primary health care (PHC) sector. This study utilizes data from a large-scale quality improvement program to examine variation in documented CVRA as a primary prevention strategy for individuals without prior CVD across four Australian jurisdictions. We also examine the proportion with elevated risk and follow-up actions recorded.MethodsWe undertook cross-sectional analysis of 2,052 client records from 97 PHC centers to assess CVRA in Indigenous adults aged ≥20 years with no recorded chronic disease diagnosis (2012–2014). Multilevel regression was used to quantify the variation in CVRA attributable to health center and client level factors. The main outcome measure was the proportion of eligible adults who had CVRA recorded. Secondary outcomes were the proportion of clients with elevated risk that had follow-up actions recorded.ResultsApproximately 23% (n = 478) of eligible clients had documented CVRA. Almost all assessments (99%) were conducted in the Northern Territory. Within this jurisdiction, there was wide variation between centers in the proportion of clients with documented CVRA (median 38%; range 0–86%). Regression analysis showed health center factors accounted for 48% of the variation. Centers with integrated clinical decision support systems were more likely to document CVRA (OR 21.1; 95% CI 5.4–82.4; p < 0.001). Eleven percent (n = 53) of clients were found with moderate/high CVD risk, of whom almost one-third were under 35 years (n = 16). Documentation of follow-up varied with respect to the targeted risk factor. Fewer than 30% with abnormal blood lipid or glucose levels had follow-up management plans recorded.ConclusionThere was wide variation in CVRA between jurisdictions and between PHC centers. Learnings from successful interventions to educate and support centers in CVRA provision should be shared with stakeholders more widely. Where risk has been identified, further improvement in follow-up management is required to prevent CVD onset and reduce future burden in Australia’s Indigenous population.

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“…As a result, this makes the reliability of applying extracted data questionable in a clinical audit. Buchan et al (2016) noted the implications of incomplete data or inconsistency in coding were that it can create unnecessary variations in care, with Duggan et al (2016) suggesting that this can lead to real patient harm due to patients not receiving the right care. The Australian Commission on Safety and Quality in Health Care (2012) reported that the data used to measure the occurrence of problems in health care is unavailable or unreliable, and patient safety is probably more difficult to assess due to the lack of systematic approaches to identify issues (Phillips et al 2010b).…”

Section: Review Of Literature On Similar Casesmentioning

confidence: 99%

Primary Sense: a new population health management tool for general practice

Davies¹

2020

Aust. J. Prim. Health

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Primary Sense is a new data extraction, analysis and reporting tool that the Gold Coast Primary Health Network (GCPHN) has developed to enable practical and effective population health management in general practice and also on a regional level. Once installed, the tool de-identifies data within the practice before running it through various clinical risk algorithms to create practical information that can easily be actioned within the general practice business model in at least two ways. The first is to generate up-to-date reports of patients who are most likely to benefit from specific interventions or occasions of service. The second is to identify potentially serious medication safety issues, alerting clinicians in real time at point of prescribing. Formal live testing of the system was completed in nine practices where 22 managers and nurses and 42 GPs used the tool over a 5-month period in 2019. The live test monitored the use of reports and alerts, and regular feedback from users enabled small but important improvements to the tool. Practice teams successfully used the reports to target specific groups of patients with outstanding care needs or who were at greatest risk of adverse health outcomes. The results of the live test showed that users found Primary Sense to be easy to use and beneficial to general practice. The next phase of this project is now underway to further trial the scalability and change management requirements for full implementation of Primary Sense. As more and more practices adopt the tool, the aggregated data will increasingly help to support population health planning, commissioning of local services, active health surveillance and other related activities.

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Clinical variation: why it matters

Cited by 21 publications

References 9 publications

Management of fever and neutropenia in children with cancer: A survey of Australian and New Zealand practice

Management of fever and neutropenia in children with cancer: A survey of Australian and New Zealand practice

Integrated Clinical Decision Support Systems Promote Absolute Cardiovascular Risk Assessment: An Important Primary Prevention Measure in Aboriginal and Torres Strait Islander Primary Health Care

Primary Sense: a new population health management tool for general practice

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