TY - JOUR T1 - Physician-level variation in clinical outcomes and resource use in inpatient general internal medicine: an observational study JF - BMJ Quality & Safety JO - BMJ Qual Saf SP - 123 LP - 132 DO - 10.1136/bmjqs-2019-010425 VL - 30 IS - 2 AU - Amol A Verma AU - Yishan Guo AU - Hae Young Jung AU - Andreas Laupacis AU - Muhammad Mamdani AU - Allan S Detsky AU - Adina Weinerman AU - Terence Tang AU - Shail Rawal AU - Lauren Lapointe-Shaw AU - Janice L Kwan AU - Fahad Razak Y1 - 2021/02/01 UR - http://qualitysafety.bmj.com/content/30/2/123.abstract N2 - Background Variations in inpatient medical care are typically attributed to system, hospital or patient factors. Little is known about variations at the physician level within hospitals. We described the physician-level variation in clinical outcomes and resource use in general internal medicine (GIM).Methods This was an observational study of all emergency admissions to GIM at seven hospitals in Ontario, Canada, over a 5-year period between 2010 and 2015. Physician-level variations in inpatient mortality, hospital length of stay, 30-day readmission and use of ‘advanced imaging’ (CT, MRI or ultrasound scans) were measured. Physicians were categorised into quartiles within each hospital for each outcome and then quartiles were pooled across all hospitals (eg, physicians in the highest quartile at each hospital were grouped together). We report absolute differences between physicians in the highest and lowest quartiles after matching admissions based on propensity scores to account for patient-level variation.Results The sample included 103 085 admissions to 135 attending physicians. After propensity score matching, the difference between physicians in the highest and lowest quartiles for in-hospital mortality was 2.4% (95% CI 0.6% to 4.3%, p<0.01); for readmission was 3.3% (95% CI 0.7% to 5.9%, p<0.01); for advanced imaging was 0.32 tests per admission (95% CI 0.12 to 0.52, p<0.01); and for hospital length of stay was 1.2 additional days per admission (95% CI 0.5 to 1.9, p<0.01). Physician-level differences in length of stay and imaging use were consistent across numerous sensitivity analyses and stable over time. Differences in mortality and readmission were consistent across most sensitivity analyses but were not stable over time and estimates were limited by sample size.Conclusions Patient outcomes and resource use in inpatient medical care varied substantially across physicians in this study. Physician-level variations in length of stay and imaging use were unlikely to be explained by patient factors whereas differences in mortality and readmission should be interpreted with caution and could be explained by unmeasured confounders. Physician-level variations may represent practice differences that highlight quality improvement opportunities. ER -