We don't know what we 're doing in medicine.... or yes we know!

This sentence was expressed by Dr. Eddy on February, 4 1990 in Detroit Free Press. He recognized the importance of the gaps in medical decision making and the effect in the efficent use of healtch care resourses.

The empirical work of Dr. John Wennberg  and various colleagues tried to find some arguments to explain that. They focused on the study of "Small Area Variations (SAV)" the phenomenom that refers to the wide variations in the per-capita utilization rates for many medical and surgical procedures that are commonly found in comparing small, contiguus hospital service markets.

They have argued that much of the observed variation is closely related to the degree of physician uncertainty with respect to diagnosis and treatment and the differences in local opinions. He's the founder editor of  The Dartmouth Atlas of Health Care 

Is there any small area variations (SAV) evidence in Spain?: Take a look at ATLAS VPM a brilliant initiative coordinated by Enrique Bernal Delgado PhD in Medicine. Senior Researcher of the Research Unit in Health Services and Policies of Aragon Institute of Health Science.

They have published 8 Atlas:

8 Potentially Preventable Hospitalizations related to exacerbation of chronic diseases
7 Variability in Hospitalizations of older people in the NHS
6 Variability in Hospitalizations due to oncological surgery in the NHS
5 Variability in Hospitalizations due to mental health problems in acute care hospitals.
4 Variability in Hospitalization due to cardiovascular problems and procedures in the NHS
3 Variability in Pediatric Hospitalizations due to surgical and diagnostic procedures selected
2 Variability in General Surgery Interventions in the NHS
1 Variability in Orthopaedic Surgery and Traumatology. Hip fracture, knee replacement and hip replacement

photo: (*) Photosolde
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