scholarly journals Practice Variation Research in Degenerative Lumbar Disc Surgery: A Literature Review on Design Characteristics and Outcomes

2021 ◽  
pp. 219256822110648
Author(s):  
Juliëtte J. C. M. Van Munster ◽  
Vera de Weerdt ◽  
Ilan J. Y. Halperin ◽  
Amir H. Zamanipoor Najafabadi ◽  
Peter Paul G. van Benthem ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Clinical Practice ◽  
Literature Review ◽  
Degenerative Disc Disease ◽  
Practice Variation ◽  
Case Mix ◽  
Disc Disease ◽  
Explanatory Variables ◽  
Unwarranted Variation ◽  
Over Time

Study Design Literature review. Objective To describe whether practice variation studies on surgery in patients with lumbar degenerative disc disease used adequate study methodology to identify unwarranted variation, and to inform quality improvement in clinical practice. Secondary aim was to describe whether variation changed over time. Methods Literature databases were searched up to May 4th, 2021. To define whether study design was appropriate to identify unwarranted variation, we extracted data on level of aggregation, study population, and case-mix correction. To define whether studies were appropriate to achieve quality improvement, data were extracted on outcomes, explanatory variables, description of scientific basis, and given recommendations. Spearman’s rho was used to determine the association between the Extreme Quotient (EQ) and year of publication. Results We identified 34 articles published between 1990 and 2020. Twenty-six articles (76%) defined the diagnosis. Prior surgery cases were excluded or adjusted for in 5 articles (15%). Twenty-three articles (68%) adjusted for case-mix. Variation in outcomes was analyzed in 7 articles (21%). Fourteen articles (41%) identified explanatory variables. Twenty-six articles (76%) described the evidence on effectiveness. Recommendations for clinical practice were given in 9 articles (26%). Extreme Quotients ranged between 1-fold and 15-fold variation and did not show a significant change over time (rho= −.33, P= .09). Conclusions Practice variation research on surgery in patients with degenerative disc disease showed important limitations to identify unwarranted variation and to achieve quality improvement by public reporting. Despite the availability of new evidence, we could not observe a significant decrease in variation over time.

Abstract P478: Trends in Concurrent Heart Failure and Acute Coronary Syndrome Hospitalizations: A Literature Review

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Sarah Godfrey ◽  
Laura Cohen ◽  
Susan Hennessy ◽  
Brandon Bellows
Keyword(s):  
Heart Failure ◽  
Acute Coronary Syndrome ◽  
Clinical Practice ◽  
Literature Review ◽  
Pooled Analysis ◽  
Coronary Syndrome ◽  
St Elevation ◽  
Recent Trends ◽  
Definition Of ◽  
Over Time

Purpose: Patients who present with concurrent heart failure (HF) and acute coronary syndrome (ACS) have an increased risk of mortality, but changes in clinical practice have improved clinical outcomes. We sought to examine recent trends in concurrent HF and ACS hospitalizations in the United States (US) through review of published literature. Methods: We searched the Medline and PubMed databases for studies published after January 1, 2000 reporting the hospitalizations for HF with concurrent acute coronary syndromes. We included studies performed in the US or with at least 25% US participants, that reported the proportion with concurrent HF and ACS, and used a clinical definition of HF (e.g. Killip Class II or III, NYHA Class, or Framingham Criteria). Studies were reviewed by and data was extracted using a standardized form. We extracted study and patient characteristics, definition of HF, and rates of concurrent HF and ACS hospitalizations. We categorized included studies by ACS type: (1) non-specific myocardial infarction (MI) or ACS, (2) non-ST elevation (NSTE) MI or NSTE-ACS, or (3) ST elevation (STE) MI. We descriptively examined recent trends in hospitalizations for concurrent HF and ACS over time; rates reported for multiple time periods or ACS types were considered separately. Results: We identified 23 observational studies, systematic reviews, and randomized clinical trials. Of these, we excluded 13 due to non-US populations, use of non-clinical definitions of HF (i.e., diagnosis codes), or not reporting rates of concurrent HF and ACS. Of the 10 included studies, 7 reported concurrent HF with non-specific MI or ACS from 1975 through 2005 across multiple registries and literature reviews. Rates ranged from 12.5% to 48.0% with no clear time-related trends. We identified 3 studies reporting concurrent HF with NSTEMI or NSTE-ACS from pooled analysis or the Global Registry of Acute Coronary Events (GRACE) registry from 1994 to 2008. Reported rates ranged from 8.2%-15.7% for studies starting in the 1990s with one study reporting and 6.1% in 2005. We identified 4 studies reporting concurrent HF with STEMI, including a pooled analysis, the GRACE registry, and a clinical trial. Rates of concurrent HF with STEMI appeared to decrease over time from 32.5% in 1990 to 1998, 15.6%-19.5% from 1999 to 2001, and 2.6%-11.0% in 2005. Conclusion: Our literature review found that there may be a decrease in concurrent HF and STEMI hospitalizations in recent decades, but no apparent trends with other types of ACS. This may be related to emphasis on early revascularization strategies, improved primary prevention, and/or earlier time to presentation due to increasing public awareness.. However, there was a dearth of data reporting concurrent HF and ACS hospitalization within the last decade. Further research is needed to understand the impact of multiple changes in clinical practice on secular trends.

scholarly journals Variations in the Adoption of Healthcare Innovation: A Literature Review

2019 ◽  
Author(s):  
Marisa Miraldo ◽  
Katharina Hauck ◽  
Antoine Vernet ◽  
Ana Wheelock
Keyword(s):  
Clinical Practice ◽  
Literature Review ◽  
New Technologies ◽  
Innovation Adoption ◽  
Practice Variation ◽  
Best Interests ◽  
Medical Decision ◽  
Medical Needs ◽  
Data Feedback ◽  
Adoption Of Innovation

Major medical innovations have greatly increased the efficacy of treatments, improved patient outcomes, and often reduced the cost of medical care. However, innovations do not diffuse uniformly across and within health systems. Due to the high complexity of medical treatment decisions, variations in clinical practice are inherent to healthcare delivery, regardless of technological advances, new ways of working, funding, and burden of disease. In this article we conduct a narrative literature review to identify and discuss peer-reviewed articles presenting a theoretical framework or empirical evidence of the factors associated with the adoption of innovation and clinical practice. We find that variation in innovation adoption and medical practice is associated with multiple factors. First, patients’ characteristics, including medical needs and genetic factors, can crucially affect clinical outcomes and the efficacy of treatments. Moreover, differences in patients’ preferences can be an important source of variation. Medical treatments may need to take such patient characteristics into account if they are to deliver optimal outcomes, and consequently, resulting practice variations should be considered warranted and in the best interests of patients. However, socioeconomic or demographic characteristics, such as ethnicity, income, or gender are often not considered legitimate grounds for differential treatment. Second, physician characteristics—such as socioeconomic profile, training, and work-related characteristics—are equally an influential component of practice variation. In particular, so-called “practice style” and physicians’ attitudes toward risk and innovation adoption are considered a major source of practice variation, but have proven difficult to investigate empirically. Lastly, features of healthcare systems—notably, public coverage of healthcare expenditure, cost-based reimbursement of providers, and service-delivery organization, are generally associated with higher utilization rates and adoption of innovation. Research shows some successful strategies aimed at reducing variation in medical decision-making, such as the use of decision aids, data feedback, benchmarking, clinical practice guidelines, blinded report cards, and pay for performance. But despite these advances, there is uneven diffusion of new technologies and procedures, with potentially severe adverse efficiency and equity implications.

scholarly journals Screening for important unwarranted variation in clinical practice: a triple-test of processes of care, costs and patient outcomes

2017 ◽  
Vol 41 (1) ◽  
pp. 104 ◽  
Author(s):  
Andrew Partington ◽  
Derek P. Chew ◽  
David Ben-Tovim ◽  
Matthew Horsfall ◽  
Paul Hakendorf ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Clinical Practice ◽  
Comparative Analysis ◽  
Improve Quality ◽  
Processes Of Care ◽  
Process Indicators ◽  
Potential Value ◽  
Triple Test ◽  
Unwarranted Variation ◽  
Care Costs

Objective Unwarranted variation in clinical practice is a target for quality improvement in health care, but there is no consensus on how to identify such variation or to assess the potential value of initiatives to improve quality in these areas. This study illustrates the use of a triple test, namely the comparative analysis of processes of care, costs and outcomes, to identify and assess the burden of unwarranted variation in clinical practice. Methods Routinely collected hospital and mortality data were linked for patients presenting with symptoms suggestive of acute coronary syndromes at the emergency departments of four public hospitals in South Australia. Multiple regression models analysed variation in re-admissions and mortality at 30 days and 12 months, patient costs and multiple process indicators. Results After casemix adjustment, an outlier hospital with statistically significantly poorer outcomes and higher costs was identified. Key process indicators included admission patterns, use of invasive diagnostic procedures and length of stay. Performance varied according to patients’ presenting characteristics and time of presentation. Conclusions The joint analysis of processes, outcomes and costs as alternative measures of performance inform the importance of reducing variation in clinical practice, as well as identifying specific targets for quality improvement along clinical pathways. Such analyses could be undertaken across a wide range of clinical areas to inform the potential value and prioritisation of quality improvement initiatives. What is known about the topic? Variation in clinical practice is a long-standing issue that has been analysed from many different perspectives. It is neither possible nor desirable to address all forms of variation in clinical practice: the focus should be on identifying important unwarranted variation to inform actions to reduce variation and improve quality. What does this paper add? This paper proposes the comparative analysis of processes of care, costs and outcomes for patients with similar diagnoses presenting at alternative hospitals, using linked, routinely collected data. This triple test of performance indicators extracts maximum value from routine data to identify priority areas for quality improvement to reduce important and unwarranted variations in clinical practice. What are the implications for practitioners? The proposed analyses need to be applied to other clinical areas to demonstrate the general application of the methods. The outputs can then be validated through the application of quality improvement initiatives in clinical areas with identified important and unwarranted variation. Validated frameworks for the comparative analysis of clinical practice provide an efficient approach to valuing and prioritising actions to improve health service quality.

scholarly journals SP4.1.6 Introduction of Concentric digital and remote consent into clinical practice during the COVID-19 pandemic

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Edward St John ◽  
Dafydd Loughran
Keyword(s):  
Quality Improvement ◽  
Clinical Practice ◽  
Royal College ◽  
Healthcare Providers ◽  
Patient Feedback ◽  
High Satisfaction ◽  
Average Patient ◽  
Unwarranted Variation ◽  
Form Information

Abstract Introduction Paper-based consent processes are associated with errors of omission, illegibility and unwarranted variation. During the COVID-19 pandemic the Royal College of Surgeons (England) released guidelines supporting the use of remote consent. The aim was to evaluate the introduction of Concentric, a digital consent application, into clinical practice. Method Between April 2020-Jan 2021, Concentric was used optionally for medical consent during registered service evaluations. Data was obtained from Concentric analytics. User and patient feedback was obtained via optional satisfaction surveys. Results 3417 Concentric consent episodes for 356 unique procedures were performed by 170 clinicians across 16 specialties from 13 healthcare providers. Patients were aged 7-101years, (median 58, IQR 30). Of the completed consent episodes (n = 2799), consent was given; remotely in 23% of episodes, and on the day of surgery in 67%. Consent form information was shared digitally with 82% of patients. Average patient user experience was 8.8 out of 10 (1 very poor - 10 excellent, n = 594). 546/594 (91.9%) patients agreed that Concentric provided all the information they needed to know. Clinicians (n = 23) rated the quality of the consent process with Concentric as 4.8 out of 5 with all supporting the use of Concentric across the Trust. Conclusion Concentric has been successfully introduced into clinical practice. Patients and clinicians report high satisfaction scores. Remote consent is feasible and trends in consent practice, such as day of surgery consent can be easily identified and can guide quality improvement work. The introduction of digital consent solutions should be considered for all units.

P37. What is Degenerative Disc Disease? A Literature Review Reveals No Answer

2009 ◽  
Vol 9 (10) ◽  
pp. 133S-134S
Author(s):  
Edward Dohring ◽  
Christopher Bono ◽  
Tom Faciszewski ◽  
Belinda Duszynski
Keyword(s):  
Literature Review ◽  
Degenerative Disc Disease ◽  
Disc Disease ◽  
Degenerative Disc

scholarly journals Understanding unwarranted variation in clinical practice: a focus on network effects, reflective medicine and learning health systems

2020 ◽  
Vol 32 (4) ◽  
pp. 271-274
Author(s):  
Femke Atsma ◽  
Glyn Elwyn ◽  
Gert Westert
Keyword(s):  
Clinical Practice ◽  
Network Effects ◽  
Practice Variation ◽  
Future Research ◽  
Patient Beliefs ◽  
The Past ◽  
Variation Patterns ◽  
Alternative Research ◽  
Clinical Variation ◽  
Unwarranted Variation

Abstract In the past decades, extensive research has been performed on the phenomenon of unwarranted clinical variation in clinical practice. Many studies have been performed on signaling, describing and visualizing clinical variation. We argue that it is time for next steps in practice variation research. In addition to describing and signaling variation patterns, we argue that a better understanding of causes of variation should be gained. Moreover, target points for improving and decreasing clinical variation should be created. Key elements in this new focus should be research on the complex interaction of networks, reflective medicine, patient beliefs and objective criteria for treatment choices. By combining these different concepts, alternative research objectives and new targets for improving and reducing unwarranted variation may be defined. In this perspective, we reflect on these concepts and propose target points for future research.

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