To the Editor: The CareTrack study1 has produced considerable debate that has mostly focused on its aggregated findings about compliance with appropriate health care delivery. There needs to be much wider discussion, not about the aggregate figure, but about the variation, such as the 39 health care providers for whom compliance varied between 32% and 86%. Such unwarranted variation in health care has been identified elsewhere through proactive initiatives.2,3
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- 1. Runciman WB, Hunt TD, Hannaford NA, et al. CareTrack: assessing the appropriateness of health care delivery in Australia. Med J Aust 2012; 197: 100-105. <MJA full text>
- 2. The Dartmouth Atlas Working Group. The Dartmouth Atlas of Health Care. Quality/effective care. http://www.dartmouthatlas.org/data/topic/topic.aspx?cat=25 (accessed Jul 2012).
- 3. National Health Service Right Care. NHS Atlas. http://www.rightcare.nhs.uk/index.php/nhs-atlas/ (accessed Jul 2012).
- 4. Dawda P, Jenkins R, Varnam R. Quality improvement in general practice [discussion paper]. London: The King’s Fund, 2010. http://www.kingsfund.org.uk/sites/files/kf/field/field_document/quality-improvement-gp-inquiry-discussion-paper-mar11.pdf (accessed Jul 2012).
- 5. Schoen C, Osborn R, Michelle MM, et al. A survey of primary care physicians in 11 countries, 2009: perspectives on care, costs, and experiences. Health Aff (Millwood) 2009; 28 (6): w1171-w1183. http://www.commonwealthfund.org/Publications/In-the-Literature/2009/Nov/A-Survey-of-Primary-Care-Physicians.aspx (accessed Jul 2012).
- 6. Resar RK. Making noncatastrophic health care processes reliable: learning to walk before running in creating high-reliability organizations. Health Serv Res 2006; 41 (4 Pt 2): 1677-1689.
I have acted as a consultant, written commissioned articles and presented as a paid speaker internationally in primary care quality improvement.