plenary speaker: k visvanathan - bc health summit 2012: variation in clinical practice
TRANSCRIPT
Let’s get it together!
Exploring variation in clinical practice
Kishore Visvanathan, MD FRCSC
Clinical Professor, University of Saskatchewan
Division Head, Urology, Saskatoon Health Region
Variation = Loss of confidence
Get your act together!
• Office manager
• Nurses
• Cancer clinic pharmacist
Variation = Confusion
Average patient recall rate (%) May - August 2008
0.00
5.00
10.00
15.00
20.00
25.00
30.00
C D I F E B G A H
Doctor
Variation = Waste
Dartmouth Atlas - Variation in Care Delivery
TURP for enlarged prostate
• 9.5 per 1,000 males– Idaho Falls, Idaho
• 1.7 per 1,000 Medicare beneficiaries– Terre Haute, Indiana
Surgery for prostate cancer
• 3.8 per 1,000 men over 65– San Luis Obispo, California
• 0.3 per 1,000 men over 65– Albany, Georgia
More than 12X different!
Prostate cancer surgery
2 X
Tu, J. et al, CMAJ Feb 7, 2012
Variation = Inappropriate care (?)
Reduce Variation
Sources of variation
System
Provider
Disease process
Patient preference
Average patient recall rate (%) May - August 2008
0.00
5.00
10.00
15.00
20.00
25.00
30.00
C D I F E B G A H
Doctor
Sooner, Safer, Smarter
Prostate cancer surgery
2 X
Variation is a symptom,
not the disease
