How much variation in clinical activity is there between general practitioners? A multi-level analysis of decision-making in primary care

Show simple item record Davis, Peter en Gribben, BM en Lay Yee, Roy en Scott, AJ en 2012-03-27T00:21:40Z en 2015-08-31T22:35:10Z en 2002 en
dc.identifier.citation Journal of Health Services Research and Policy, 2002, 7 (4), pp. 202 - 208 (7) en
dc.identifier.issn 1355-8196 en
dc.identifier.uri en
dc.description.abstract Objectives: There is considerable policy interest in medical practice variation (MPV). Although the extent of MPV has been quantified for secondary care, this has not been investigated adequately in general practice. Technical obstacles to such analyses have been presented by the reliance on ecological small area variation (SAV) data, the binary nature of many clinical outcomes in primary care and by diagnostic variability. The study seeks to quantify the extent of variation in clinical activity between general practitioners by addressing these problems. Methods: A survey of nearly 10 000 encounters drawn from a representative sample of general practitioners in the Waikato region of New Zealand was carried out in the period 1991-1992. Participating doctors recorded all details of clinical activity for a sample of encounters. Measures used in this analysis are the issuing of a prescription, the ordering of a laboratory test or radiology examination, and the recommendation of a future follow-up office visit at a specified date. An innovative statistical technique is adopted to assess the allocation of variance for binary outcomes within a multi-level analysis of decision-making. Results: As expected, there was considerable variability between doctors in levels of prescribing, ordering of investigations and requests for follow up. These differences persisted after controlling for case-mix and patient and practitioner attributes. However, analysis of the components of variance suggested that less than 10% of remaining variability occurred at the practitioner level for any of the measures of clinical activity. Further analysis of a single diagnostic group - upper respiratory tract infection - marginally increased the practitioner contribution. Conclusions: The amount of variability in clinical activity that can definitively be linked to the practitioner in primary care is similar to that recorded in studies of the secondary sector. With primary care doctors increasingly being grouped into larger professional organisations, we can expect application of multi-level techniques to the analysis of clinical activity in primary care at different levels of organisational complexity. en
dc.publisher Royal Society of Medicine Press Limited en
dc.relation.ispartofseries Journal of Health Services Research and Policy en
dc.relation.replaces en
dc.relation.replaces 2292/15555 en
dc.rights Items in ResearchSpace are protected by copyright, with all rights reserved, unless otherwise indicated. Previously published items are made available in accordance with the copyright policy of the publisher. Details obtained from en
dc.rights.uri en
dc.title How much variation in clinical activity is there between general practitioners? A multi-level analysis of decision-making in primary care en
dc.type Journal Article en
dc.identifier.doi 10.1258/135581902320432723 en
pubs.issue 4 en
pubs.begin-page 202 en
pubs.volume 7 en
dc.description.version AM - Accepted Manuscript en
dc.rights.holder Copyright: Royal Society of Medicine Press Limited en
dc.identifier.pmid 12425779 en
pubs.end-page 208 en
dc.rights.accessrights en
pubs.subtype Article en
pubs.elements-id 55487 en Arts en Arts Research en Compass en
pubs.record-created-at-source-date 2010-09-01 en
pubs.dimensions-id 12425779 en

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