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Title: Factors influencing variation in blood product usage : an international perspective
Author: Laspina, Stefan
ISNI:       0000 0004 6496 5741
Awarding Body: University of Warwick
Current Institution: University of Warwick
Date of Award: 2017
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Introduction and Aims Despite the availability of evidence-based guidelines, blood transfusion, one of the commonest procedures in health care, manifests significant variation across different countries that appear to have comparable health systems. This is corroborated by extensive data on blood usage in coronary artery bypass graft surgery, a sentinel procedure, which also suggests that the variation may be related to institutional practice. Regional use of red cells within the same country, data for which had not yet been collated to date, was elicited, and it confirmed the same pattern of variation where the highest-using regions tend to transfuse double the red cells transfused in the lowest-using ones. Methods Since the reasons for it are largely unknown, analyses of available data from Australia, New Zealand, Canada, the USA, and 24 countries in Europe, were performed using linear correlation and regression analysis, to identify potential predictors and possible effectors of this variation. Results Apart from confirming a known demographic predictor, proportion of the population over 65 years (p = 0.01), another 4 predictors were identified including clinical activity as represented by coronary artery bypass graft surgery (p = 0.001) and health funding (p = 0.007), which together explained 70% of the variation in red cell usage. Similar regression models for platelets and plasma showed an R square value of 0.31 and 0.247 respectively. The variation in blood product use did not correlate at all with health service outcomes and performance, but correlated quite tightly with markers of supply sensitive care making a strong case for unwarranted variation in blood transfusion. Red cell use, for example, correlated with the availability of diagnostic technology as represented, amongst others, by the number of MRI units (r = 0.665, p = 0.001). Moreover, it was shown that countries that use more of one product use more of the others. A relationship was also found between blood product usage and cultural constructs capturing the notions of professional uncertainty and difficulty with accepting new evidence. Conclusions Irrational and evidence-denying variation in blood transfusion practice exists and can be measured relatively easily. Comparison of clinical use of blood in discrete geographical regions may be useful as a general measure of the effectiveness of the implementation of different tools to improve practice, not just within the context of blood transfusion but in clinical practice in general.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: RM Therapeutics. Pharmacology