Exploring Variation in Care: Alternative Conceptual Models
Authors: Michaela A. Dinan, Kevin A. Schulman
Journal: Annals of Internal Medicine (2014)

Editorials2 December 2014Exploring Variation in Care: Alternative Conceptual ModelsMichaela A. Dinan, PhD and Kevin A. Schulman, MDMichaela A. Dinan, PhDFrom Duke Clinical Research Institute and Duke University School of Medicine, Durham, North Carolina.Search for more papers by this author and Kevin A. Schulman, MDFrom Duke Clinical Research Institute and Duke University School of Medicine, Durham, North Carolina.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M14-2382 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail In this issue, McWilliams and colleagues (1) report an assessment of variation in the use of imaging services for men with prostate, lung, or colorectal cancer receiving care in the Veteran Affairs (VA) health care system or Medicare. They asked, “Does a health care system with lower use of health care services exhibit less geographic variation in the use of these services?” Surprisingly, the researchers found the opposite of what they expected. Despite lower use within the VA system, they observed greater geographic variation in the use of cancer-related imaging tests within the VA system than within Medicare. Specifically, they ...References1. McWilliams JM, Dalton JB, Landrum MB, Frakt AB, Pizer SD, Keating NL. Geographic variation in cancer-related imaging: Veterans Affairs health care system versus Medicare. Ann Intern Med. 2014;161:794-802. doi:10.7326/M14-5100 LinkGoogle Scholar2. Gottlieb DJ, Zhou W, Song Y, Andrews KG, Skinner JS, Sutherland JM. Prices don't drive regional Medicare spending variations. Health Aff (Millwood). 2010;29:537-43. [PMID: 20110290] doi:10.1377/hlthaff.2009.0609 CrossrefMedlineGoogle Scholar3. Yasaitis LC, Bynum JP, Skinner JS. Association between physician supply, local practice norms, and outpatient visit rates. Med Care. 2013;51:524-31. [PMID: 23666491] doi:10.1097/MLR.0b013e3182928f67 CrossrefMedlineGoogle Scholar4. Skinner J, Staiger D. Technology adoption from hybrid corn to beta blockers. Working Paper 11251. Cambridge, MA: National Bureau of Economic Research; 2005. Accessed at www.nber.org/papers/w11251.pdf on 23 October 2014. Google Scholar5. Zuckerman S, Waidmann T, Berenson R, Hadley J. Clarifying sources of geographic differences in Medicare spending. N Engl J Med. 2010;363:54-62. [PMID: 20463333] doi:10.1056/NEJMsa0909253 CrossrefMedlineGoogle Scholar6. Olson RA, Tiwana MS, Barnes M, Kiraly A, Beecham K, Miller S, et al. Use of single- versus multiple-fraction palliative radiation therapy for bone metastases: population-based analysis of 16,898 courses in a Canadian province. Int J Radiat Oncol Biol Phys. 2014;89:1092-9. [PMID: 25035213] doi:10.1016/j.ijrobp.2014.04.048 CrossrefMedlineGoogle Scholar7. Landon BE, Keating NL, Barnett ML, Onnela JP, Paul S, O'Malley AJ, et al. Variation in patient-sharing networks of physicians across the United States. JAMA. 2012;308:265-73. [PMID: 22797644] doi:10.1001/jama.2012.7615 CrossrefMedlineGoogle Scholar8. Ariely D. The (Honest) Truth About Dishonesty. New York: HarperCollins 2012. Google Scholar9. Freeman VG, Rathore SS, Weinfurt KP, Schulman KA, Sulmasy DP. Lying for patients: physician deception of third-party payers. Arch Intern Med. 1999;159:2263-70. [PMID: 10547165] CrossrefMedlineGoogle Scholar10. Dinan MA, Curtis LH, Hammill BG, Patz EF, Abernethy AP, Shea AM, et al. Changes in the use and costs of diagnostic imaging among Medicare beneficiaries with cancer, 1999-2006. JAMA. 2010;303:1625-31. [PMID: 20424253] doi:10.1001/jama.2010.460 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Duke Clinical Research Institute and Duke University School of Medicine, Durham, North Carolina.Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-2382.Corresponding Author: Kevin A. Schulman, MD, Duke Clinical Research Institute, PO Box 17969, Durham, NC 27715; e-mail, kevin.[email protected]edu.Current Author Addresses: Drs. Dinan and Schulman: Duke Clinical Research Institute, PO Box 17969, Durham, NC 27715. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoGeographic Variation in Cancer-Related Imaging: Veterans Affairs Health Care System Versus Medicare J. Michael McWilliams , Jesse B. Dalton , Mary Beth Landrum , Austin B. Frakt , Steven D. Pizer , and Nancy L. Keating Geographic Variation in Cancer-Related Imaging: Veterans Affairs Health Care System Versus Medicare J. Michael McWilliams , Jesse B. Dalton , Mary Beth Landrum , Austin B. Frakt , Steven D. Pizer , and Nancy L. Keating Metrics 2 December 2014Volume 161, Issue 11Page: 835-836KeywordsBoneHealth careHealth care utilizationMedical servicesMedicareMotivationSocial influenceSurgeryTreatment guidelinesVeteran care ePublished: 2 December 2014 Issue Published: 2 December 2014 Copyright & PermissionsCopyright © 2014 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...