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Variation in clinical practice: forests and trees revisited

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Abstract

Variations in clinical practice are commonly viewed as a sign of uneven quality of care and attributed to provider self-interest. However, patient preferences, physician practice patterns, and diagnostic and therapeutic uncertainty also cause variations. Greater attention to both doctor–patient interactions and limits to the available evidence might enable more effective assessment and improvement of health-care quality.

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Authors and Affiliations

  1. Institute of Health Policy, Management & Evaluation, University of Toronto, 155 College Street, Toronto, M5T M36, Ontario, Canada

    Christopher J. D. Wallis, C. David Naylor & Allan S. Detsky

  2. Department of Surgery, University of Toronto, 149 College Street, Toronto, M5T 1P5, Ontario, Canada

    Christopher J. D. Wallis

  3. Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Suite A305a, Toronto, M4N 3M5, Ontario, Canada

    Christopher J. D. Wallis

  4. Department of Medicine, University of Toronto, 200 Elizabeth Street, Toronto, M5G 2C4, Ontario, Canada

    C. David Naylor & Allan S. Detsky

  5. Department of Medicine, Mount Sinai Hospital and University Health Network, 600 University Ave, Room 429, Toronto, M5G 1X5, Ontario, Canada

    Allan S. Detsky

Authors
  1. Christopher J. D. Wallis
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  2. C. David Naylor
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  3. Allan S. Detsky
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Corresponding author

Correspondence to Christopher J. D. Wallis.

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The authors declare no competing financial interests.

Supplementary information

Supplementary information S1 (table)

Factors contributing to variation in clinical service delivery (PDF 56 kb)

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FURTHER INFORMATION

Crossing the quality chasm: a new health system for the 21st century

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Wallis, C., Naylor, C. & Detsky, A. Variation in clinical practice: forests and trees revisited. Nat Rev Urol 14, 511–512 (2017). https://doi.org/10.1038/nrurol.2017.102

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  • DOI: https://doi.org/10.1038/nrurol.2017.102

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