The Dartmouth Atlas Project has released the first four of nine regional reports looking at the variation in elective surgery rates for 306 hospital referral regions across the U.S. The report shows that whether Medicare patients undergo elective surgery depends largely on where they live and the providers they see. Authors found that for many conditions, especially those where elective surgery is an option, the treatment a patient receives depends more on the physician’s recommendations than the patient’s preferences.
Earlier this month, I attended a conference held in honor of Jack Wennberg recognizing his many years of work on geographic practice variation in health care and the huge impact his work has had. For two days, folks from around the world who have collaborated with Jack or have been influenced by his work, gathered together to discuss his legacy. During the event, Dartmouth College announced the establishment of the John E. Wennberg Distinguished Professorship in Jack’s honor.
As many of you know, in 1967, Jack discovered significant variations in rates of procedures within the State of Vermont. This finding led to investigations of geographic variations in health care across the United States, as well as between and within countries worldwide. What is most important to recognize is that Jack didn’t rest after making these discoveries; he made it a point to do something to address the issue. Jack not only founded the Dartmouth Institute for Health Policy & Clinical Practice and the Dartmouth Atlas of Health Care, but also co-founded the Informed Medical Decisions Foundation with Al Mulley in order to start informing and involving patients in their care and decrease unwanted practice variations.
Jack Fowler, our senior scientific advisor, presented the first day about the Patient Outcome Research Teams (PORTs), which set out to study the results of different strategies of care in terms that were meaningful to patients. Jack (Wennberg) helped found this research program and led one of the first PORTs on prostate diseases. I followed Jack’s (Fowler) presentation to discuss how the work done by the PORTs is still influencing day-to-day patient care. John Billings, our first president and current chairman of the Foundation’s board of directors, gave a wonderful presentation, sharing our nearly 25 year history in a 15-minute presentation. George Bennett, the founder of Health Dialog, and Al, who with Jack (Wennberg) are key figures in our history, further discussed shared decision making and our work over the last two and a half decades.
While there were many distinguished guests in attendance, one that should be noted is Don Berwick, former head of the Centers for Medicare and Medicaid Services and a current Massachusetts gubernatorial candidate. Don was a keynote speaker, discussing the challenges of health care reform and how Jack was a major influence on his career and way of thinking.
Jack continues to study practice variation and his impact on health care continues to this day. For example, he and his colleagues at The Dartmouth Institute recently published The Dartmouth Atlas of Medicare Prescription Drug Use
, which examines how rates of drug prescription vary drastically across the country. As evidenced by the findings in that study and others, we can expect many more important contributions from our friend and co-founder, Jack Wennberg.
Posted in Current News, President's Corner
Tagged Al Mulley, Centers for Medicare and Medicaid Services, Dartmouth Atlas, Don Burwick, geographic variation, George Bennett, Jack Fowler, Jack Wennberg, John Billings, Michael Barry, PORTs
For more than 20 years, the Dartmouth Atlas Project has documented significant variations in the distribution and usage of health care resources in the United States. A key resource in understanding our health care system, the project serves as a foundation for ongoing activities to improve our overall system.
This report addresses a deceptively simple question: How can the productivity of American health care be substantially improved? Productivity, in lay terms, is the ratio of output to inputs. A more colloquial rendition of the question might be: how can we get a lot more bang for our heath care buck?
Posted in Cost, Health Care Policy, Patient Involvement, SDM Implementation
Tagged cost-effective medical care, Dartmouth Atlas, EMR, health care, health care innovation, informed consent, Kauffman Foundation, patient empowerment, patients, shared decision making