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July 10, 2013

Variations in Health Care, Patient Preferences, and High-Quality Decision Making

Author Affiliations
  • 1Section of Cardiovascular Medicine and the Robert Wood Johnson Foundation Clinical Scholars Program
  • 2Department of Medicine, Yale University School of Medicine
  • 3Department of Health Policy and Management, Yale School of Public Health
  • 4Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
JAMA. 2013;310(2):151-152. doi:10.1001/jama.2013.7835

Practice variation in clinical care for preference-sensitive decisions should be a call to action to optimize clinical decision making. Preference-sensitive decisions are those that involve considerable tradeoffs and do not have an option that is clearly superior in all respects.1 Practice variations, which may be influenced by factors that are extrinsic to the patient, occur among physicians, hospitals, health care organizations, regions, and health care systems.1 The variations in practice should disturb physicians not merely because they may indicate wasteful practices but because of the possibility that such variations do not optimally serve the best interests of patients. The health care system should allow variation in practice, provided that variation is based on patient clinical differences and preferences rather than on other factors such as payment method, geography, or system proclivities.