A systematic review of medical practice variation in OECD countries.
BACKGROUND
Major variations in medical practice have been documented internationally. Variations raise questions about the quality, equity, and efficiency of resource allocation and use, and have important implications for health care and health policy.


OBJECTIVE
To perform a systematic review of the peer-reviewed literature on medical practice variations in OECD countries.


METHODS
We searched MEDLINE to find publications on medical practice variations in OECD countries published between 2000 and 2011. We present an overview of the characteristics of published studies as well as the magnitude of variations for select high impact conditions.


RESULTS
A total of 836 studies were included. Consistent with the gray literature, there were large variations across regions, hospitals and physician practices for almost every condition and procedure studied. Many studies focused on high-impact conditions, but very few looked at the causes or outcomes of medical practice variations.


CONCLUSIONS
While there were an overwhelming number of publications on medical practice variations the coverage was broad and not often based on a theoretical construct. Future studies should focus on conditions and procedures that are clinically important, policy relevant, resource intensive, and have high levels of public awareness. Further study of the causes and consequences of variations is important.
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
Ashley N
AN
Corallo
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
Ruth
R
Croxford
The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Medical School, Hanover, NH, USA.
David C
DC
Goodman
The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Medical School, Hanover, NH, USA.
Elisabeth L
EL
Bryan
Organisation for Economic Cooperation and Development, Paris, France.
Divya
D
Srivastava
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Medical School, Hanover, NH, USA; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. Electronic address: stukel@ices.on.ca.
Therese A
TA
Stukel
D000553:Ambulatory Care / Q000706:statistics & numerical data; D003695:Delivery of Health Care / Q000706:statistics & numerical data; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D066150:Organisation for Economic Co-Operation and Development / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians'; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data
Diagnostic techniques and procedures; Health policy; OECD; Physician practice patterns; Small area analysis; Systematic review; Variations