Currently, the decision as to what constitutes an acceptable level of precision is based on one or more factors including intended clinical application, biological variation, regulatory guidelines, medical opinions, and guidelines from professional groups [ 30].
Before 2002, there was regional variation in guidelines.
There is considerable variation in guidelines as to the threshold to define clinical significant proteinuria.
Before 2000 there was both regional variation in guidelines and in their implementation in the Netherlands.
There seems to be a 'guideline industry' emerging in many Western countries with a considerable variation in guidelines from different sources (Grol et al, 1998a).
Strengths of this study are the large study sample (N = 423) derived from a population-based cancer registry and the validated guideline-based QIs used for the assessment of variation in guideline adherence for NHL care.
ESA management is also labor intensive and time consuming for health care providers, requiring frequent hemoglobin monitoring to ensure that guideline targets are maintained, dose changes for hemoglobin variation above guideline ranges, and depending on the ESA half-life, administration up to three times a week to maintain appropriate hemoglobin concentrations [ 23].
Conclusions: Large variations between guidelines have been observed which would translate in large practice variations, if the guidelines were systematically applied.
Large variation in guideline adherence between hospitals is often associated with lower quality of care, since guidelines aim to assist professionals to deliver the most optimal care.
For measures of prescribing variation, ideally, guideline recommendations should be taken into account.
84% of the variation in guideline adherence was located at the GAI-level.
