THE AMBIGUOUS RELATIONSHIP BETWEEN PRACTICE VARIATION AND APPROPRIATENESS OF CARE - AN AGENDA FOR FURTHER RESEARCH

The analysis of variation in the use of health care services, and part icularly of practice variation, has been the subject of renewed intere st because of the view that the inappropriate use of procedures could be a major cause of these differences. In this article, recent literat ure is reviewed and the results of personal research are described on both the variation in care provision and on appropriateness assessment . In the few studies which have focussed on both subjects no evidence has yet been found to suggest that practice variation is to be explain ed by differences in appropriateness rates. However, there are still m any methodological pitfalls in both variation analyses (statistical pr oblems) and appropriateness assessment (reliability of the judgement), implying that this conclusion is far from definitive. More research s hould therefore be conducted on methodological questions of variation analysis and appropriateness assessment. Furthermore in variation anal ysis the relative contribution of all potential determinants has to be studied on the various levels of care provision. Finally, to study th e relationship between practice variation and appropriateness of care, the clinical problem and not the procedure should be the starting poi nt.