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Chapter 16. Variations in Care

Variation in clinical practice is evidence of poor-quality care.

A. Always

B. Never

C. Only if the clinical practice is preference sensitive

D. None of the above

The three categories of care Wennberg defined for the purpose of studying variation in clinical processes are

A. warranted, unwarranted, and preference sensitive.

B. variably used, underused, and overused.

C. effective, preference sensitive, and supply sensitive.

D. preference sensitive, supply sensitive, and provider sensitive.

Variation in a clinical process or outcome is warranted when

A. it is explained by differences in patient preference, disease prevalence, or other patient- or population-related factors.

B. it occurs within a provider’s patient population over time but not when it occurs among providers in different geographic regions.

C. it is explained by physicians’ preferences and habits developed during clinical training.

D. a control chart plotted for the clinical process or outcome measure shows it to be in statistical control.

Unwarranted variation in an effective clinical process suggests

A. the correct rate of use is equal to the average rate of use among all providers.

B. underuse where this process of care is provided to less than 100% of the patient population in which the evidence shows its benefits outweigh the risks.

C. there is a need for greater patient involvement in decisions about care.

D. there is a need for better risk adjustment in the statistical model.

Which of the following is true?

A. Special cause variation arises from a single or small set of causes that can be traced and identified

B. Incidents of special cause variation can be useful in identifying opportunities and targets for quality improvement

C. Common cause variation cannot be traced to root causes

D. All of the above are true

Factors that can contribute to unwarranted variation in use of clinical processes include


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