ArticleBMJ quality & safety2011
The meaning of variation to healthcare managers, clinical and health-services researchers, and individual patients.
Article in BMJ quality & safety, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 1 of them a synthesis that pooled it.
What it found
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
22 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Variation in antibiotic use among and within different settings: a systematic review.The Journal of antimicrobial chemotherapy · 2018Pooled it
- The impact of a prescription review and prescriber feedback system on prescribing practices in primary care clinics: a cluster randomised trial.BMC family practice · 2018Trial
- Shared Decision-Making, Sphincter Preservation, and Rectal Cancer Treatment: Identifying and Executing What Matters Most to Patients.Clinics in colon and rectal surgery · 2024Review
- Health-care organization characteristics in cancer care delivery: an integrated conceptual framework with content validation.Journal of the National Cancer Institute · 2024Article
- Observational
- Core concepts in pharmacoepidemiology: Measures of drug utilization based on individual-level drug dispensing data.Pharmacoepidemiology and drug safety · 2022Review
- Patient, physician and geographic predictors of cardiac stress testing strategy in Ontario, Canada: a population-based study.BMJ open · 2022Article
- Article
- Improving Services for HIV-Exposed Infants in Zambia and Cameroon Using a Quality Improvement Collaborative Approach.Global health, science and practice · 2021Article
- Using Quality Improvement to Increase Access to Palliative Care.JCO oncology practice · 2021Article
- Article
- How Do We Know a Change is an Improvement? The (Not So) New Scientific Knowledge Every Physician Should Learn, Master and Lead.Arquivos brasileiros de cardiologia · 2020Article
- Understanding corporate governance of healthcare quality: a comparative case study of eight Australian public hospitals.BMC health services research · 2019Article
- Development of a program theory for clinical pathways in hospitals: protocol for a realist review.Systematic reviews · 2019Article
- Albuminuria measurement in diabetic care: a multilevel analysis measuring the influence of accreditation on institutional performance.BMJ open quality · 2019Article
- Making care better in the pediatric intensive care unit.Translational pediatrics · 2018Review
- Process mapping as a framework for performance improvement in emergency general surgery.Canadian journal of surgery. Journal canadien de chirurgie · 2018Article
- Domains associated with successful quality improvement in healthcare - a nationwide case study.BMC health services research · 2017Article
- Does this treatment work for me? The patient's role in assessing medical care.BMJ innovations · 2017Article
- So what? Now what? Exploring, understanding and using the epistemologies that inform the improvement of healthcare.BMJ quality & safety · 2011Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Healthcare managers, clinical researchers and individual patients (and their physicians) manage variation differently to achieve different ends. First, managers are primarily concerned with the performance of care processes over time. Their time horizon is relatively short, and the improvements they are concerned with are pragmatic and 'holistic.' Their goal is to create processes that are stable and effective. The analytical techniques of statistical process control effectively reflect these concerns. Second, clinical and health-services researchers are interested in the effectiveness of care and the generalisability of findings. They seek to control variation by their study design methods. Their primary question is: 'Does A cause B, everything else being equal?' Consequently, randomised controlled trials and regression models are the research methods of choice. The focus of this reductionist approach is on the 'average patient' in the group being observed rather than the individual patient working with the individual care provider. Third, individual patients are primarily concerned with the nature and quality of their own care and clinical outcomes. They and their care providers are not primarily seeking to generalise beyond the unique individual. We propose that the gold standard for helping individual patients with chronic conditions should be longitudinal factorial design of trials with individual patients. Understanding how these three groups deal differently with variation can help appreciate these three approaches.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.