Small Area Variation

Small area variation refers to the degree to which the rate of use of specific treatments and procedures varies by geographic region.

Beginning with studies in the 1970s, researchers have documented large regional variations in the frequency at which specific interventions are used that are not explained by underlying differences in patient populations. Instead, these differences are due, at least in part, to variations in physician practice patterns, local supply of physicians, and local availability of facilities. For example, the number of days per capita that people living in a region are hospitalized correlates with the number of registered hospital beds in that region.

Ideally, variations in the rates of procedures and other interventions should reflect variations in preferences, values, and the underlying health status of patients, rather than physician practice patterns. Involving patients in decisions about their care is a strategy for reducing inappropriate variation in care.

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