Study finds significant variations in physicians' treatment plans, care

Physician care varies widely, with some physicians much more likely to deliver proper care than others, even those working in the same area or organization, according to an analysis published Jan. 28 in JAMA Health Forum.

Researchers examined 2016-19 medical insurance records provided in 14 common clinical scenarios by 8,788 physicians from seven different specialties across five metropolitan U.S. areas. Researchers determined whether physicians applied evidence-based guidelines to choices made in common clinical scenarios.

"We looked at a set of situations where clear-cut guidelines have been in place for years, with the hope of limiting variation in physician decision-making and promoting the use of the most appropriate care, based on rigorous evidence," said Zirui Song, MD, PhD, lead study author, associate professor of healthcare policy at Harvard Medical School and general internist at Massachusetts General Hospital, both based in Boston.

"In some of the cases we looked at, physicians who made the most clinically appropriate decisions were five to 10 times more likely to use the recommended standard of care than peers in the same specialties and cities whose decisions tended to be the least appropriate," Dr. Song said. "The differences we found are a cause for concern."

The variations are most likely related to individual differences, not differences in health systems, as the variation between individual physicians working in the same organization was greater than the differences in performance between organizations, according to Dr. Song. 

Researchers have long suspected that the care variation tied to physicians contributes U.S. healthcare spending waste, according to Dr. Song, who said, "This study offers evidence that this problem is large and widespread across specialties."

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