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dc.contributorWichita State University. Department of Public Health Sciencesen_US
dc.contributor.authorLong, Michael J.en_US
dc.identifier.citationJournal of evaluation in clinical practice. 2002 May; 8(2): 167-74.en_US
dc.descriptionClick on the DOI link below to access the article (may not be free).en_US
dc.description.abstractPractice style variation, or variation in the manner in which physicians treat patients with a similar disease condition, has been the focus of attention for many years. The research agenda is further intensified by the unrealistic assumption that by reducing variation, quality will be improved, costs will be reduced, or both. There is a wealth of literature that identifies differences in health care use of many kinds, in apparently similar communities. Attempts have been made by many scholars to identify the determinants of variation in terms of differences in the population characteristics (e.g. age, sex, insurance, etc.) and geographical characteristics (e.g. distance to provider, number of physicians, number of hospital beds, etc.). When significant differences in use rates prevail after controlling for differences in population characteristics, it is often attributed to 'uncertainty', or the fact that there is no consensus on what constitutes the optimum treatment process. It is suggested by this literature that the greatest variation can be found in the circumstances where there is the most 'uncertainty'. In this work, a physician resource demand model is proposed in which it is suggested that, during the diagnosis and treatment process, physicians demand resources consistent with the clinical needs of the patients, modified by the intervening forces under which they practice. These intervening forces, or constraints, are categorized as patient agency constraints, organizational constraints and environmental constraints, which are characterized as 'induced variation'. It is suggested that when all of the variables that constitute these constraints are identified, the remaining variance represents 'innate variance', or practice style differences. It is further suggested that the more completely this model is specified, the more likely area differences will be attenuated and the smaller will be the residual variance.en_US
dc.publisherWiley-Blackwell Publishingen_US
dc.relation.ispartofseriesJournal of Evaluation In Clinical Practiceen_US
dc.relation.ispartofseriesJ Eval Clin Practen_US
dc.subject.meshDecision Makingen_US
dc.subject.meshModels, Theoreticalen_US
dc.subject.meshPhysician's Practice Patternsen_US
dc.titleAn explanatory model of medical practice variation: a physician resource demand perspectiveen_US
dc.description.versionpeer revieweden_US
dc.rights.holderCopyright © 2002 Blackwell Scienceen_US

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