A fundamental tenet of CQI and EBM authenticity is the following – the “random” variation we observe in any measured outcome among hospitals/clinics is almost always far greaterthan the purported beneficial effect of any given therapy,…..”breakthrough” therapies, BTW, that are often expensive and invasive and wasteful.
Examples – the gap between bronchopulmonary dysplasia rates reported b/w high and low performers is much more than the purported benefits of high frequency ventilation,…..the difference in severe retinopathy of prematurity rates between high and low performers is greater than the purported benefits of servo-controlled saturation controls,…..ditto NEC rates and probiotic use,……ditto prematurity rates and elaborate outpatient monitoring schemes,…..
Look at your own specialties and I am certain you will discover many similar examples. The point – unexplained variation in basic diagnostics and therapeutics, unmeasured processes that are imbedded in day-to-day care are hardly “random”,….they are imbedded choices/habits and often poorly evidence-based. When unpeeled our practice choices often divulge secrets of variant outcomes. This is tremendously exciting and optimistic in my experience because it means that soooooo much improvement in value and safety can be had. How you ask? By doggedly focusing on standardizing proven determinants of health, and minimizing variation b/w providers using only solid PBPs (potentially better practices),……rather than endlessly searching for more “breakthrough” therapies ($$$$$$).
Attached are three wonderful examples: 1) if teen-agers sleep more they are healthier, 2) a healthy diet reduces anxiety, and 3) preventing excessive weight gain b/w ages 2 and 6 years of age is critical to preventing adult obesity (which accounts for 25 to 40 cents on every healthcare dollar we spend).
Another tenet of CQI and EBM wisdom – The patient should be the source of reasoned variation in care,.…not the provider.
Joe Kaempf, MD