John Wennberg, professor of community and family medicine at Dartmouth Medical School, received the 2007 Emory Codman Award for his leadership in the area of regional variations of health care quality. He received the award last week from the Joint Commission, one of the principal standard-setting and accrediting organizations in the country.
Wennberg was also named the "most influential health policy researcher of the last 25 years" on Nov. 1 by Health Affairs magazine for his research in the same field.
Wennberg began his research 40 years ago as an inspector of regional health planning programs for Vermont. Over the course of his inspections he noticed significant differences in the quantity of health care received in different regions.
Areas with a large number of hospitals and doctors per person tend to have higher costs without a corresponding increase in quality. Wennberg and his colleagues were surprised to find that health care costs are supply driven.
"The linkage between capacity and quality is tenuous at best," Wennberg said. "Most studies have shown that areas with more conservative levels of use at acute care hospitals actually have better quality."
Wennberg also found that many surgical procedures are determined not by nationally recognized best practices, but by local tastes and preferences.
Wennberg and his colleagues were among the first to make in-depth comparisons of health care in different regions. When they published their findings in 1971, it was met with widespread skepticism, Wennberg said.
"There was a lot of disbelief that practices could vary that much," he said. "It took a lot of research to prove that this variance was genuine and not related. Up to that point in time most people believed the practice of medicine was fundamentally scientific, such variation should not occur but does and continues to occur."
Wennberg went on to establish and direct Dartmouth's Center for the Evaluative Clinical Sciences, which publishes the Dartmouth Atlas of Health care, a database that measures how medical care is delivered across the country. He also helped establish the Foundation for Informed Medical Decision Making, which advocates more patient participation in medical decisions. The Center for the Evaluative Clinical Sciences was recently renamed the Institute for Health Policy and Clinical Practice.
Wennberg said that in the time since he first published his research, the government now has a better understanding of what causes the regional variation, but has not succeeded in decreasing this variation. Many areas such as Miami and Los Angeles continue to offer lower-quality health care at a high cost. Other hospitals, such as the Mayo Clinic in Minnesota, continue to lead the nation in high quality, inexpensive health care.
Wennberg credited DHMC with leading the way to change the health care industry by focusing on the quality of results. At DHMC, patients are actively involved in their treatment decisions, Wennberg said. He added that when many patients are given full information about an elective procedure, they often decide not to undergo surgery, causing costs to go down.
It is crucial, Wennberg said, that such reforms begin now because unless major changes are made, the situation is likely to get much worse with the aging of the baby boomer generation.
"With the retirement of the baby boom generation there is going to be a huge growth of chronic illnesses," he said. "There are going to be many more treatment options. Unless we have a strong idea of how they work, we're going to be continually bombarded with articles in the paper over the health care crisis we're facing. We're going to have to improve a lot."
