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