Unwarranted variations in healthcare delivery: implications for academic medical centres

Everyday clinical practice is characterised by wide variations that cannot be explained by illness severity or patient preference. Professor Wennberg examines the causes for these variations and suggests ways to remedy the situation Academic medicine has had only limited success in improving the scientific basis of everyday clinical practice, even within the walls of its own hospitals. Patterns of practice among academic medical centres—as among other institutions—are often idiosyncratic and unscientific, and local medical opinion and local supply of resources are more important than science in determining how medical care is delivered. In short, after nearly 100 years of academic medicine as we know it,…