ReviewJournal of evaluation in clinical practice2020
Unwarranted clinical variation in health care: Definitions and proposal of an analytic framework.
Review in Journal of evaluation in clinical practice, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 88 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
88 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Consensus-Building Processes for Implementing Perioperative Care Pathways in Common Elective Surgeries: A Systematic Review.Journal of advanced nursing · 2025Pooled it
- Can feedback approaches reduce unwarranted clinical variation? A systematic rapid evidence synthesis.BMC health services research · 2020Pooled it
- Measuring and Improving Evidence-Based Patient Care Using a Web-Based Gamified Approach in Primary Care (QualityIQ): Randomized Controlled Trial.Journal of medical Internet research · 2021Trial
- Variations in general practitioners' referrals to low-value MRI examinations in Norway: A nationwide register-based study.The European journal of general practice · 2026Article
- A Multi-Indicator Concentration Index for Primary-Care Reimbursement Analytics: Evidence from the Albanian Health-Insurance System.Healthcare (Basel, Switzerland) · 2026Article
- Variation in Vasoactive Treatment Selection for Cardiogenic Shock: Insights From the Critical Care Cardiology Trials Network (CCCTN).Circulation. Heart failure · 2026Article
- Variation in antenatal anaemia guidelines across the NHS in the United Kingdom: A cross-sectional study.British journal of haematology · 2026Article
- Comment on 'Clinical Presentation and Early Outcomes of Congenital Endocrine Salt-Wasting Syndromes Unrelated to 21-Hydroxylase Deficiency'.Endocrinology, diabetes & metabolism · 2026Article
- Patient-, Clinician-, and Institution-level Variation in Intraoperative Antihypertensive Use: A Multicenter Observational Analysis.Journal of cardiothoracic and vascular anesthesia · 2026Observational
- Reducing unwarranted variation in low-value health care in Norway: description of the NOR programme.Research in health services & regions · 2026Article
- Enhancing neonatal vascular access: proposing a patient-centered framework based on 7-Rights.Pediatric research · 2026Article
- Revealing the gaps: unwarranted variations and multidisciplinary solutions in Victorian oesophagogastric cancer care - A mixed-methods analysis.BMC health services research · 2026Article
- The Children's Urgent Reduction of Forearm Fractures in the Emergency Department (CURFFED) project : a national prospective trainee-led collaborative audit of practice.Bone & joint open · 2026Article
- Identifying Clinical Variations Across NSW Public Dental Service: An Essential Step to Develop a Roadmap for Value-Based Oral Healthcare.Australian dental journal · 2026Article
- Multidisciplinary Clinical Quality Indicators for Head and Neck Cancer: A Modified Delphi Study in Australia.ANZ journal of surgery · 2026Article
- Conducting rigorous implementation evaluations in real word settings: lessons from a consensus approach to perioperative pathway implementation for elective surgery.Implementation science communications · 2026Article
- Advancing Methods to Study Clinical Variation in Healthcare.Journal of evaluation in clinical practice · 2026Review
- Understanding and Addressing Clinical Variation in Rectal Cancer Care: Application of an Analytic Framework.Asia-Pacific journal of clinical oncology · 2026Article
- Barriers and facilitators to the delivery of delirium care in intensive care units: an analysis informed by the Theoretical Domains Framework.Anaesthesia · 2026Article
- The Norwegian Adult Mental Health Registry for Quality Control in Specialized Mental Health Services: Protocol for a Nationwide Naturalistic Study.JMIR research protocols · 2026Article
28 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
2 authors.
Funding
Abstract
RATIONALE, AIMS, AND
objectivesUnwarranted clinical variation is a topic of heightened interest in health care systems around the world. While there are many publications and reports on clinical variation, few studies are conceptually grounded in a theoretical model. This study describes the empirical foundations of the field and proposes an analytic framework.
methodStructured construct mapping of published empirical studies which explicitly address unwarranted clinical variation.
resultsA total of 190 studies were classified in terms of three key dimensions: perspective (assessing variation across geographical areas or across providers); criteria for assessment (measuring absolute variation against a standard, or relative variation within a comparator group); and object of analysis (using process, structure/resource, or outcome metrics).
conclusionConsideration of the results of the mapping exercise-together with a review of adjustment, explanatory and stratification variables, and the factors associated with residual variation-informed the development of an analytic framework. This framework highlights the role that agency and motivation, evidence and judgement, and personal and organizational capacity play in clinical decision making and reveals key facets that distinguish warranted from unwarranted clinical variation. From a measurement perspective, it underlines the need for careful consideration of attribution, aggregation, models of care, and temporality in any assessment.
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What OpenQuestion holds
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.