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Archive for Evidence-based planning



Jack Wennberg, all hail!

by Matthew Holt

Now some really good stuff. Jack Wennberg (future Nobel Prize winner if my campaign ever gets off the ground) says that most practice variation is due to provider opinion. And of course his Dartmouth Atlas shows how huge that variation is.

One way to change this is to improve decision aids at the right moment in time….when decision aids are used, and patients are fully informed—for example, in breast cancer, women are 94% correct on the trade off issues for lumpectomy/mastectomy. And women are starting to make decisions based on their values (preventing local recurrence vs. loss of breast).

The other problem is supply-sensitive care. Frequency of care is based on the supply of facilities. He showed a chart where admission for hip fracture stayed the same per 1000 capita–you’ve either got one or not. Whereas admissions for all medical conditions varied in a direct correlation to the supply of hospital beds. And by the way supply of resources is not correlated with illness levels!

He showed the classic system chart from the Dartmouth work looking at the US News and World report on AMCs and the huge variation between different AMCs. A 4 fold variation in resource use between these medical centers for the same outcome!

And of course the places with less care, have lower hospital admissions, and better outcomes! There’s much more about Wennberg and his colleagues’ work at THCB.