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International Studies in Phenomenology and Philosophy

Book | Chapter

204125

Positive deviance in health care

beware of pseudo-equifinality

David C. AronBrigid WilsonChin-Lin TsengOrysya SorokaLeonard M. Pogach

pp. 189-198

Abstract

Objective Identification of best practices constitutes an important strategy for organizational improvement. We compared different criteria (different measurement thresholds, different comparators, and performance consistency over time) on identification of high-performing facilities, especially positive deviants.Methods The design was serial cross-sectional, using yearly VHA administrative data (2009–2013). Our primary outcome measure was facility-level rate of HbA1c overtreatment of diabetes in patients at risk for hypoglycemia. Outlier status was assessed by three methods.Results From 2009 to 2013, the rate of overtreatment overall based on a threshold of 6.5% decreased from 28.6% in 2009 to 22.7% in 2013; the rate of undertreatment increased from 7 to 10.3%. Fourteen facilities were identified in the lowest decile of overtreatment. Undertreatment rates among these facilities were compared to the mean overall undertreatment rate; several facilities identified as positive deviants based on overtreatment rates had exceptionally high rates of undertreatment.Conclusion Because two facilities may arrive at the same results via very different pathways, it is important to consider that a best practice may actually reflect a separate worst practice.

Publication details

Published in:

Sturmberg Joachim P. (2018) Putting systems and complexity sciences into practice: sharing the experience. Dordrecht, Springer.

Pages: 189-198

DOI: 10.1007/978-3-319-73636-5_14

Full citation:

Aron David C., Wilson Brigid, Tseng Chin-Lin, Soroka Orysya, Pogach Leonard M. (2018) „Positive deviance in health care: beware of pseudo-equifinality“, In: J. P. Sturmberg (ed.), Putting systems and complexity sciences into practice, Dordrecht, Springer, 189–198.