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This article presents a theoretic framework, "patient practice variation," currently missing from the investigations of medical care variation. Resource utilization, immediate, and long-term outcomes may be better explained by including utilities under control of the patient into small area variation studies. This especially may be important in the area of prenatal and maternal care and certain chronic diseases, such as diabetes. The quality of care measures must incorporate patient satisfaction and quality of life in addition to more objective physiologic outcomes.
Daniel R. Longo (Sat,) studied this question.