Clinical variation is like climate change
- Michael Van Duren, MD
For many of us, our awareness of climate change has been brought to the forefront with the rise in natural events over the recent years. Tsunamis, fires, tornadoes, earthquakes and a melting ice cap; we are much more aware of climate change than ever before. With all the news and the awareness, we often think to ourselves, “What is my role in reducing climate change?” It can be overwhelming.
Many of us don’t know where to start. Should I buy a new EV or is it better if I just drive my SUV into the ground? Is the metal straw the answer? Paper straw? Do I need to buy products from specific manufacturers? Which of my lifestyle choices will allow me to best do my part in reversing the effects of climate change?
Reducing clinical variation is equally frustrating
When it comes to reducing clinical variation, many of you may have that same frustration. You know that clinical variation is costing patients more and your organization is losing money. You know that it is leading to inconsistent care. You also know the negative impact it has on patient outcomes – and experiences.
Some of you may question whether clinical variation is really your concern at all, but there’s a little voice in your head suggesting that it just might be. What should you do?
Enter Choosing Wisely
Choosing Wisely is “an initiative of the ABIM Foundation that seeks to advance a national dialogue on avoiding unnecessary medical tests, treatments and procedures.” What they are doing is trying to focus on only the most valuable and necessary care. Why? Because we know that over treatment is a big part of medical waste. In fact, research suggests that $100 billion worth of clinical over treatment occurs every year.1 That’s a sum worth reducing.
But how do you know exactly where there is clinical waste?
Choosing Wisely has created a number of resources that help “identify tests or procedures commonly used in their field whose necessity should be questioned and discussed. This call to action has resulted in specialty-specific lists of “Things Providers and Patients Should Question.” Now you have some very specific areas you can look to for possible clinical waste.
That sounds like a lot of work
If you look at the lists available on Choosing Wisely, your first response might be, “There is no possible way we can effectively track or enforce these types of recommendations. How would I possibly do that? Besides that, you can’t tell physicians what to do.”
Changing practice patterns without annoying physicians
Here is where some physician leaders might like to lean heavy on clinical decision support (CDS) systems. This is certainly understandable and completely appropriate – especially in cases that are more black and white in nature. What happens when there is a little more nuance in the diagnosis? (Which, by the way, is much of medicine.) This is where research suggests that peer comparison can be powerful. 2 3 4
Peer comparison highly effective in accelerating practice change
Peer comparison shows physicians how their practice patterns compare to those of their peers. When they see a respected colleague practicing more effectively than themselves, they ask “Hmmm, is that true? If so, what is that physician doing differently than I am?” This leads to a self-directed change and greater engagement between colleagues.
A surprisingly simple first step to reducing clinical variation
It turns out that if you know these areas that “providers and patients should question,” you can then use those areas as practice patterns to measure. Add precise attribution, physician-specific metrics, and peer comparison, and you have a tool for accelerating practice pattern change. This happens to be exactly what Agathos does.
It takes more than just data – It must be data physicians use
Let’s be clear, precise attribution and physician-specific metrics are not a cake walk. That’s why Agathos put together a group of experienced data scientists, engineers, and physician advisors to develop a data platform that physicians actually engage with. It’s almost unheard of to have an 86% engagement rate of physicians with their data, and yet, that’s what Agathos clients see. Beyond that, they see the practice pattern changes they wanted in the first place.
Summary – What can you do to make a dent in clinical variation?
If we go back to the opening challenge of where to start in reducing clinical variation, you hopefully can now see that there is a clear path forward: Give physicians personalized data about how their practice patterns compare to their peers, encourage them to collaborate and discuss those differences, and then watch how quickly variation begins to level out.
Now you can finally sleep well, knowing you did everything you could to do right by both your hospital and your patients, even if you don’t know how to save the rest of the world.
1. Shrank et al., 2019 “Waste in the US Health Care System: Estimated Costs and Potential for Savings.” JAMA.
2. Albertini et al., 2019 “Evaluation of a Peer to Peer Data Transparency Intervention for Mohs Micrographic Surgery Overuse,” JAMA Dermatology.
3. Meeker et al., 2016 “Effect of Behavioral Interventions on Inappropriate Antibiotic Prescribing Among Primary Care Practices,” JAMA.
4. Navathe et al., 2016, “Physician Peer Comparisons as a Nonfinancial Strategy to Improve the Value of Care,” JAMA.