I attended the 6th annual Wennberg International Collaborative (WIC) Fall Research Meeting in London September 2–4, 2015. This invitation-only meeting is a collaboration between The Dartmouth Institute (TDI) and the London School of Economics and Political Science (LSE). The WIC is a research network committed to improving health care by examining organizational and regional variation in health care resources, utilization, and outcomes. The goal of the collaboration is to better understand the causes and consequences of unwarranted variation—that is, variation in health care not explained by differences in population needs or preferences—around the world, leading to clinical improvement and policy change.
The collaboration also celebrates and extends globally the work of Jack Wennberg, founder of The Dartmouth Atlas and cofounder of the Informed Medical Decisions Foundation. Although Jack couldn’t attend this year, Al Mulley, also cofounder of the Foundation, represented Dartmouth. David Goodman, a pediatrician and health services researcher, as well as coprincipal investigator of The Dartmouth Atlas, cochaired the meeting with Gywn Bevan, professor of health policy at the LSE.
About 65 people from 20 countries attended the meeting, held at the Royal College of Surgeons of England. The meeting focused on scientific data presentations describing practice variations, but there were policy presentations on addressing those variations as well, particularly from England, Scotland, Spain, New Zealand, and Australia; the Australians seemed particularly adept at policy interventions to address unwanted practice variations.
The meeting was largely a forum to establish collaborations and provide constructive comments on ongoing work from like-minded people; most attendees were researchers working on practice variation in their own countries, and many had attended previous WIC gatherings. The plenary speakers were Elliot Fisher, director of TDI, who spoke about the Accountable Care Organization movement in the U.S.; Andreas Taenzer, an anesthesiologist from Dartmouth, who talked about reducing variation in sepsis care to improve outcomes in the High Value Health Collaborative; Estella Geraghty, chief medical officer at Esri, who talked about creating “Smart Hospitals” using Esri’s geographic information system (GIS) software; and myself. I talked about shared decision making (SDM) as an “antidote” for unwanted practice variation. A number of investigators from different countries approached me about how SDM could be studied and advanced in their own countries.
Anne Brabers, a researcher from the Netherlands, presented a clinical trial of a decision support program to help women decide about single (less effective) or dual (higher likelihood of twins) embryo implantation following in vitro fertilization. They documented a modest reduction in practice variation across hospitals using this approach.
One limitation of global research in practice variation is the availability of data. Members of the collaborative developed a statement that addresses this limitation, “Driving Health Care Improvement Without a Map: A Call for Improved Data Availability.” The “bottom line” of the document: “We as members of the Wennberg International Collaborative call for full and open access to health care data and information for legitimate research and policy analysis.” Many individuals at the meeting, including myself, endorsed the statement.
Going forward, WIC plans to have a “roving” international meeting in the spring that will be country-specific (this year it was held in Berlin), and the fall meeting in London as usual. For my part, I was honored to attend the meeting on behalf of the Informed Medical Decisions Foundation and Healthwise, and I look forward to further work in support of addressing unwanted practice variation.