|
March – April 2020
A message from Dr. S. George Kipa, deputy chief medical officer
Understanding variation in clinical care
 Our understanding of the nature of significant variation in clinical care has been informed and enhanced by efforts such as the Dartmouth Atlas Project* and, more recently, by the Blue Cross and Blue Shield Association Health of America reports.
Many of us have heard examples of the huge variation cost of cardiac care as it relates to something as seemingly simple as the city in which the care is received. The Health of America study on the cost variation for percutaneous coronary interventions in the U.S. is a good resource on this topic. And the Dartmouth Atlas Project now provides public access to data* on a variety of health care procedures so anyone can download it, analyze it and come up with their own conclusions.
Health Catalyst, a data warehousing and analytics company, mentions four top sources of variations in clinical care in an article* on its website:
- An increasingly complex health environment
- Exponentially increasing medical knowledge
- Lack of valid clinical knowledge
- An over-reliance on subjective knowledge.
It also mentions three care category groupings that help us understand clinical variation:
- Effective care, defined as interventions for which the benefits far outweigh the risks
- Preference sensitive care, defined as clinical care driven by informed patient choice
- Supply sensitive care, defined as care for which the frequency of use relates to the capacity of the local health care system
In addition, statistical process control concepts, such as common cause (random) and special cause variation, help us measure and analyze variation within the context of our local systems of care. Continuous quality improvement tools, such as flow charts, fishbone diagrams and storyboards — when combined with an understanding of the categories of variation and with such business methodologies as lean thinking — have been key to successful transformation that leads to a decrease in inappropriate clinical variation.
Blue Cross Blue Shield of Michigan’s Collaborative Quality Initiatives, part of Value Partnerships, offer a window into how these tools are being used to understand and modify sources of inappropriate variation, leading to clinical care improvement and widespread adoption of best practices. For example, the Blue Cross Blue Shield of Michigan Cardiovascular Consortium, or BMC2, demonstrated in 1998 how using our CQI tools can greatly decrease unnecessary variation in coronary angioplasties.
Our CQIs are not only bringing about substantial clinical transformation in many different areas but have helped pave the way for the move from a fee-for-service payment model to value-based care.
We live in a time of incredible access to mountains of information. Sadly, the busy clinician is easily frustrated and overwhelmed by the amount of information, combined with the lack of time to seek and find crucial answers. Many organizations within the health care industry are aware of this challenge and are working to find solutions. As more sources of integrated data become available for analysis by advanced tools, we’ll all have additional opportunities for improvement.
Our vision of the future of health care is that we’ll have access to clinical decision support systems that will inform clinicians and patients of their best possible options — and do it seamlessly, without undue burdens of time and effort. For this to happen, we must seek to understand and meet the challenges of real-time health care data access and interoperability. The groundbreaking efforts of the Michigan Health Information Network Shared Services,* or MiHIN, to collect and provide clinicians with timely information on their patient populations are a big step in the right direction.
Additional helpful references:
*Blue Cross Blue Shield of Michigan doesn’t own or control this website. |
