When faced with the same set of facts, healthcare providers often make different diagnoses, employ different tests and prescribe disparate therapies.
Dr Esrailian and colleagues from California, USA performed a national survey to measure process of care and variations in decision-making in Crohn's disease.
The research team then compared results between experts and community providers.
The researchers constructed a survey with 5 vignettes to elicit provider beliefs regarding the appropriateness of diagnostic tests and therapies in Crohn's disease.
The research team measured agreement between community gastroenterologists and Crohn's disease experts.
|There was evidence of ‘extreme variation' within groups|
|Alimentary Pharmacology & Therapeutics|
Variation within each group using the RAND Disagreement Index (DI), which is a validated measure of provider variation, was also measured.
The team received 186 responses.
Experts and community providers generally agreed on diagnostic testing decisions in Crohn's disease.
However, there was a significant disagreement between groups for several decisions, use of 5-aminosalicylate in particular.
There was evidence of ‘extreme variation' within groups across a range of decisions.
Dr Esrailian's team concludes, "Experts and community providers are in general consensus about diagnostic decision-making in Crohn's disease."
"Extreme variation exists both between and within groups for key therapeutic decisions in Crohn's disease."
"We must understand and decrease this variation prior to future efforts of creating explicit quality indicators in Crohn's disease."