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Innovations in Health Care Delivery
May 24/31, 2016

Development and Implementation of Expected Practices to Reduce Inappropriate Variations in Clinical Practice

Author Affiliations
  • 1Los Angeles County Department of Health Services, Los Angeles, California
JAMA. 2016;315(20):2163-2164. doi:10.1001/jama.2016.4255

Variation in clinical practice is substantial and is associated with poorer health outcomes, increased costs, and disparities in care.1,2 Substantial attention has been given to reducing unnecessary differences in practice patterns.3 Despite these efforts, practice variation has been difficult to overcome. Challenges to reducing variation include heterogeneity and gaps in clinicians’ knowledge; economic incentives for undesired clinical behaviors; concerns about malpractice risk; physicians’ value of autonomy and personal preference; inadequate communication and decision support tools; and imbalances between clinical demand and resource capacity. Another fundamental barrier to practice standardization is that good clinical practice must sometimes vary to reflect a patient’s specific social, environmental, and biological situation. Sometimes a standard practice would not be best for a given patient. Hence, efforts to legislate or establish policies governing care have been limited because they impede the common sense that there are nearly always exceptions to a given rule.