Practice Variations: A Challenge for Physicians

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Abstract
Variation in the utilization rates of medical treatments and surgical procedures has been shown to occur across both large regions and small areas. In this issue ofTHE JOURNAL, a series of studies1-3examines the hypothesis that levels of inappropriate use explain geographic variations. In particular, they test the hypothesis that areas exhibiting relatively high levels of utilization also experience a higher percentage of inappropriate care. In examining this hypothesis, the appropriateness of the application of coronary angiography, carotid endarterectomy, and upper gastrointestinal tract endoscopy was examined and correlated with rates of utilization across 13 treatment sites in 1981. The findings of the study did not "support the hypothesis that areas with high use of medical and surgical procedures exhibit these high rates primarily or to any meaningful extent, because physicians in these areas perform procedures more often for inappropriate indications than their counterparts in areas of lower use."

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