Improving the Quality of Care — Can We Practice What We Preach?

Abstract

It has been 30 years since Wennberg and Gittelsohn published their landmark article demonstrating substantial variation among different geographic areas in the provision of medical services.¹ Since then, investigators have found variation in the delivery of virtually every aspect of health care that has been examined. From the perspective of the quality of care, the variation that is the greatest cause for concern is that between actual practice and evidence-based “best practice.”Over the past 30 years, progress has been made in several areas that are vital to quality improvement. Practice guidelines have become more rigorously evidence-based and are now . . .