Variation in dental treatment – Why?

Variation in clinical decisions

Variation in clinical decisions

Variation in clinical decisions

Variation in clinical decisions

Variation in clinical decisions

Treatment recommendations for individual teeth made by 15 dentists for the same patient

Treatment recommendations for individual teeth made by 15 dentists for the same patient

Treatment recommendations for individual teeth made by 15 dentists for the same patient

2.  Intraclass correlation coefficient (rho) for agreement among dentists’ recs for restorative tx due to caries, for teeth grouped by restoration and caries status

2.  Intraclass correlation coefficient (rho) for agreement among dentists’ recs for restorative tx due to caries, for teeth grouped by restoration and caries status

2.  Intraclass correlation coefficient (rho) for agreement among dentists’ recs for restorative tx due to caries, for teeth grouped by restoration and caries status

Variation in decision-making – Phases of decision-making

Variation in decision-making – Diagnostic phase

Variation in decision-making – Diagnostic phase

Variation in decision-making – intervention phase

Variation in decision-making – treatment choice phase

Variation in decision-making – treatment choice phase

Investigating reasons for variation

Slide 20

Investigating reasons for variation

Investigating reasons for variation

Investigating reasons for variation

Delivery System within which tx provided –Source of Variation

The Clinician as Service Deliverer -
Clinician characteristics – variation source

The Clinician as Service Deliverer –
Style of practice – variation source

The Clinician as Service Deliverer
The practice setting – variation source

The Clinician as Service Deliverer
 Role of Professional Leadership – variation source

The Clinician as Service Deliverer
Income earner – variation source

Differences in how dentists Interact with Patients  - Variation source

The Clinician as Patient’s Agent
Patient’s economic agent – variation source

The Clinician as Patient’s Agent
The Patient’s Clinical Agent – variation source

The Clinician as Patient’s Agent
The Patient’s Clinical Agent – variation source
Dealing with uncertainty

The Clinician as Patient’s Agent
The Patient’s Clinical Agent – variation source
Dealing with uncertainty

The Clinician as Patient’s Agent
The Patient’s Clinical Agent – variation source
Dealing with uncertainty

The Clinician as Patient’s Agent
The Patient’s Clinical Agent – variation source
Dealing with uncertainty

The Clinician as Patient’s Agent
The Patient’s Clinical Agent – variation source
Dealing with uncertainty

The Clinician as Patient’s Agent
The Patient’s Clinical Agent – variation source
Uncertainty

The Clinician as Patient’s Agent
The Patient’s Clinical Agent – variation source
Uncertainty

Implications of variation in treatment

Implications of variation in treatment

How to change behavior?

Do Education and Feedback change clinician’s decisions?