Variation in medical care: time for action.

Variations research has broken new ground by moving analysis of Medicare data from the community to the hospital level. The California study of hospitals further illustrates the power of comparing performance to demonstrate the levels of efficiency that can be achieved. WellPoint, replicating the Dartmouth approach with its commercial data, is partnering with medical specialty societies to make data "actionable" and move beyond benchmarking to help providers alter practice patterns.

When excuses run dry: transforming the U.S. health care system.

Mainstream media have reported on the wide variation in clinical practice documented for years by health service researchers. Raising awareness of the quality and cost implications of clinical variation, however, is not enough to adopt clinical behavior based on the principles of evidence-based medicine (EBM). Preoccupation with EBM's limitations--which can be overcome--and failure to address its misperceptions inhibit transformation to an evidence-based system of care and payment.