A systematic review of medical practice variation in OECD countries.

BACKGROUND: Major variations in medical practice have been documented internationally. Variations raise questions about the quality, equity, and efficiency of resource allocation and use, and have important implications for health care and health policy. OBJECTIVE: To perform a systematic review of the peer-reviewed literature on medical practice variations in OECD countries. METHODS: We searched MEDLINE to find publications on medical practice variations in OECD countries published between 2000 and 2011. We present an overview of the characteristics of published studies as well as the magnitude of variations for select high impact conditions. RESULTS: A total of 836 studies were included. Consistent with the gray literature, there were large variations across regions, hospitals and physician practices for almost every condition and procedure studied. Many studies focused on high-impact conditions, but very few looked at the causes or outcomes of medical practice variations. CONCLUSION: While there were an overwhelming number of publications on medical practice variations the coverage was broad and not often based on a theoretical construct. Future studies should focus on conditions and procedures that are clinically important, policy relevant, resource intensive, and have high levels of public awareness. Further study of the causes and consequences of variations is important.

A population-based study of paediatric emergency department and office visits for concussions from 2003 to 2010.

BACKGROUND: There is a paucity of information regarding descriptive epidemiology of paediatric concussions over time, and few studies include both emergency department (ED) and physician office visits. OBJECTIVE: To describe trends in visits for paediatric concussions in both EDs and physician offices according to age and sex. A secondary objective was to describe the cause of concussion for children treated in EDs. METHODS: A retrospective, population-based study using linked health administrative data from all concussion-related visits to the ED or a physician office by school-age children and youth (three to 18 years of age) in Ontario between April 1, 2003 and March 3, 2011 was conducted. RESULTS: The number of children evaluated in both EDs and a physician offices increased between 2003 and 2010, and this linear trend was statistically significant (P=0.002 for ED visits and P=0.001 for office visits). The rate per 100,000 increased from 466.7 to 754.3 for boys and from 208.6 to 440.7 for girls during the study period. Falls accounted for approximately one-third of the paediatric concussions. Hockey/skating was the most common specific cause of paediatric sports-related concussions. CONCLUSIONS: The increasing use of health care services for concussions is likely related to changes in incidence over time and increased awareness of concussion as a health issue. Evidence-based prevention initiatives to help reduce the incidence of concussion are warranted, particularly in sports and recreation programs.

HISTORIQUE: On possède peu d'information sur l'épidémiologie descriptive des commotions cérébrales en pédiatrie au fil du temps, et rares sont celles qui portent à la fois sur les visites à l'urgence et au cabinet du médecin. OBJECTIF: Décrire les tendances des visites à l'urgence et au cabinet du médecin par une population d'âge pédiatrique en raison de commotions cérébrales, en fonction de l'âge et du sexe. Un objectif secondaire consistait à décrire la cause des commotions cérébrales chez les enfants traités à l'urgence. MÉTHODOLOGIE: Des chercheurs ont mené une étude rétrospective en population reliant les données administratives en matière de santé de toutes les visites d'enfants d'âge scolaire et d'adolescents (de trois à 18 ans) à l'urgence ou au cabinet du médecin en raison d'une commotion cérébrale en Ontario, entre le 1er avril 2003 et le 3 mars 2011. RÉSULTATS: Le nombre d'enfants évalués à l'urgence ou au cabinet du médecin a augmenté entre 2003 et 2010, et cette tendance linéaire était statistiquement significative (P=0,002 pour les visites à l'urgence et P=0,001 pour celles en cabinet). Pendant la période de l'étude, le taux sur 100 000 enfants est passé de 466,7 à 754,3 chez les garçons et de 208,6 à 440,7 chez les filles. Les chutes représentaient environ le tiers des commotions cérébrales en pédiatrie, tandis que le hockey ou le patin était la principale cause de commotions cérébrales liées au sport. CONCLUSIONS: L'utilisation croissante des services de santé en raison d'une commotion cérébrale est probablement liée à l'évolution de leur incidence et à une plus grande sensibilisation à leurs conséquences sur la santé. Il faudra entreprendre des initiatives de prévention fondées sur des données probantes pour contribuer à réduire l'incidence des commotions cérébrales, notamment dans le cadre des programmes sportifs et de loisirs.