ABSTRACT
I. Introduction Quality improvement (QI) efforts and the evolution of expectations regarding cystic fibrosis (CF) care that has occurred in the last decade are best understood in the context of the overall health care delivery system. Wide variations in the processes and outcomes of care among patients being treated for the same health care problems in different locations and health care settings was first noted by Wennberg and Gittelsohn in the mid-1970s (1). This phenomenon was initially of interest to health economists, who focused on the magnitude of variations in health care expenditures across delivery sites, but it soon became clear that this variation in practice led to differences in patient outcomes. While some variation in an activity as complex as medical practice is inevitable, there is a challenge and opportunity to identify the variations that produce better outcomes. From this standpoint, failure to learn from the variation would be a far more serious indictment of the profession than the variation itself (2).
