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Rose AJ. Improving the management of warfarin may be easier than we think. Circulation. 2012 Nov 6; 126(19):2277-9.
Performance variation is easy to find - all one needs to do is to look for it. We have long known that some nations achieve better control of hypertension than others,(1) some hospitals have shorter door-to-balloon times than others,(2) and some cardiac surgeons have better risk-adjusted mortality after coronary artery bypass graft surgery than others.(3) In fact, it is difficult to recall an instance where performance was found not to vary. Given that performance variation is ubiquitous, it is no longer shocking to find it; the more interesting question is why performance varies so much. The answer to this question would likely be a key step along the pathway to improving performance.