Tuesday, September 01, 2015

MA Health Quality Partners display variation

Here's some nice work from the Massachusetts Health Quality Partners, a part of their Practice Pattern Variation Analysis (PPVA) program. There are 40 conditions identified by MHQP where they have identified significant differences in the use of medical services for similar conditions. The idea is that:

Clinical leadership can address the causes of the variation and determine whether the variation is clinically warranted, how to initiate change if it is not, and consider how the variation impacts quality, safety and cost. Through PPVA, the medical community can work  toward adoption of community developed standards and actions that will improve quality care for patients.

I think this is a thoughtful approach to variation, one that is engaging and respectful of clinicians.  I was interested to see this recent example:

One of the conditions MHQP's PPVA program identified as a strong opportunity to better understand variation was the frequency of ultrasounds during pregnancy.  

Major epidemiological studies on this matter have not been undertaken since the 1990s, when the equipment emitted only one eighth of the acoustic energy being emitted with today's modern equipment (2012 British Institute of Radiology). Moreover, an analysis of published literature released by the Cochran Collaboration on fetal ultrasound concluded that "routine scans do not seem to be associated with reductions in adverse outcomes for babies" (Cochrane Collaboration 2010).

In 2014 MHQP's statewide PPVA program  identified the number of ultrasounds after the first trimester in uncomplicated pregnancies as one of over 40 conditions that demonstrated significant practice variation among clinical providers.  MHQP engaged with Massachusetts Chapter of the American College of Obstetricians and Gynecologists and concluded that  for the Massachusetts commercial patient population, the average number of ultrasounds per uncomplicated pregnancy after the first trimester was greater than 4, with patients receiving between as few as 1 and as many as  9 ultrasounds per pregnancy. 

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