Seminal Research Studies
The following articles represent our most significant and influential research papers. A comprehensive bibliography is listed below. Articles are listed in order of publication date, with the most recent listed first.

2008
Baker LC, Fisher ES, Wennberg JE. Variations in hospital resource use for Medicare and privately insured populations in California. Health Affairs 2008 Feb;27(2):w123-w134.

Goodman DC, Grumbach K. Does having more physicians lead to better health system performance? JAMA 2008 Jan;299(3):335-7.

2007
Wennberg JE, O'Connor AM, Collins ED, Weinstein JN. Extending The P4P Agenda, Part 1: How Medicare Can Improve Patient Decision Making And Reduce Unnecessary Care. Health Affairs 2007 Nov;26(6):1564-74.

Wennberg JE, Fisher ES, Skinner JS, Bronner KK. Extending The P4P Agenda, Part 2: How Medicare Can Reduce Waste And Improve The Care Of The Chronically Ill. Health Affairs 2007 Nov;26(6):1575-85.

O'Connor AM, Wennberg JE, Legare F, Llewellyn-Thomas HA, Moulton BW, Sepucha KR, Sodano AG, King JS. Toward The 'Tipping Point': Decision Aids And Informed Patient Choice. Health Affairs 2007 May-Jun;26(3):716-725.

Barnato AE, Herndon MB, Anthony DL, Gallagher PM, Skinner JS, Bynum JP, Fisher ES. Are Regional Variations in End-of-Life Care Intensity Explained by Patient Preferences?: A Study of the US Medicare Population. Med Care 2007 May;45(5):386-93.

2006
Fisher ES, Staiger DO, Bynum JPW, Gottlieb DJ. Creating Accountable Care Organizations: The Extended Hospital Medical Staff. Health Affairs web exclusive, 5 December 2006; 10.1377/hlthaff.26.1.w44.

Goodman DC, Stukel TA, Chang CH, Wennberg JE. End-of-life care at academic medical centers: Implications for future workforce requirements. Health Affairs 2006;25(2):521-31.

Skinner JS, Staiger DO, Fisher ES. Is technological change in medicine always worth it? The case of acute myocardial infarction. Health Affairs web exclusive, 7 February 2006; 10.1377/hlthaff.25.w34.

2005
Wennberg JE, Fisher ES, Baker L, Sharp SM, Bronner KK. Evaluating the efficiency of California providers in caring for patients with chronic illness. Health Affairs web exclusive, 16 November 2005; 10.1377/hlthaff.w5.526.
      More information      Supplemental tables

Goodman DC. The physician workforce crisis: Where is the evidence? Health Affairs web exclusive, 15 March 2005; 10.1377/hlthaff.w5.108.

2004
Wennberg JE, Fisher ES, Stukel TA, Sharp SM. Use of Medicare claims data to monitor provider-specific performance among patients with severe chronic illness. Health Affairs web exclusive, 7 Oct 2004; 10.1377/hlthaff.var.5.
      Supplemental tables

Fisher ES, Wennberg DE, Stukel TA, Gottlieb DJ. Variations in the longitudinal efficiency of academic medical centers. Health Affairs web exclusive, 7 Oct 2004; 10.1377/hlthaff.var.19.

Goodman DC. Twenty-year trends in regional variations in the U.S. physician workforce. Health Affairs web exclusive, 7 Oct 2004; 10.1377/hlthaff.var.90.

Wennberg JE. Practice variations and health care reform: Connecting the dots. Health Affairs web exclusive, 7 Oct 2004; 10.1377/hlthaff.var.140.

Wennberg JE, Fisher ES, Stukel TA, Skinner JS, Sharp SM, Bronner KK. Use of hospitals, physician visits, and hospice care during last six months of life among cohorts loyal to highly respected hospitals in the United States. BMJ. 2004;328:607-610.
      Supplemental tables

2003
Fisher ES, Wennberg DE, Stukel TA, Gottlieb DJ, Lucas FL, Pinder EL. The implications of regional variations in Medicare spending. Part 1: The content, quality, and accessibility of care. Ann Intern Med. 2003 Feb 18;138(4):273-87.
      Supplemental table

Fisher ES, Wennberg DE, Stukel TA, Gottlieb DJ, Lucas FL, Pinder EL. The implications of regional variations in Medicare spending. Part 2: Health outcomes and satisfaction with care. Ann Intern Med. 2003 Feb 18;138(4):288-98.

2002
Wennberg JE, Fisher ES, Skinner JS. Geography and the debate over Medicare reform. Health Affairs web exclusive, 13 February 2002; 10.1377/hlthaff.w2.96.

1990s and earlier
Fisher ES, Welch HG. Avoiding the unintended consequences of growth in medical care: How might more be worse? JAMA. February 3, 1999;Vol 281, No. 5.

Wennberg J, Gittelsohn A. Small area variations in health care delivery: A population-based health information system can guide planning and regulatory decision-making. Science. 1973;182:1102-08.
Other Research Studies
2008
Weinstein JN, Tosteson TD, Lurie JD, Tosteson AN, Blood E, Hanscom B, Herkowitz H, Cammisa F, Albert T, Boden SD, Hilibrand A, Goldberg H, Berven S, An H; SPORT Investigators. Surgical versus nonsurgical therapy for lumbar spinal stenosis. N Engl J Med 2008 Feb;358(8):794-810.

Goodney PP, Lucas FL, Likosky DS, Malenka DJ, Fisher ES. Changes in the use of carotid revascularization among the Medicare population. Arch Surg 2008 Feb;143(2):170-3.

Pearson AM, Blood EA, Frymoyer JW, Herkowitz H, Abdu WA, Woodward R, Longley M, Emery SE, Lurie JD, Tosteson TD, Weinstein JN. SPORT lumbar intervertebral disk herniation and back pain: does treatment, location, or morphology matter? Spine 2008 Feb;33(4):428-35.

Tosteson AN, Stout NK, Fryback DG, Acharyya S, Herman BA, Hannah LG, Pisano ED; DMIST Investigators. Cost-effectiveness of digital mammography breast cancer screening. Ann Intern Med 2008 Jan;148(1):1-10.

2007
Tosteson AN, Gottlieb DJ, Radley DC, Fisher ES, Melton LJ 3rd. Excess mortality following hip fracture: the role of underlying health status. Osteoporos Int 2007 Nov;18(11):1463-72.

Weinstein JN, Clay K, Morgan TS. Informed Patient Choice: Patient-Centered Valuing Of Surgical Risks And Benefits. Health Affairs 2007 May-Jun;26(3):726-30.

Baicker K, Fisher ES, Chandra A. Malpractice Liability Costs And The Practice Of Medicine In The Medicare Program. Health Affairs 2007 May-Jun;26(3):841-852.

Weinstein JN, Lurie JD, Tosteson TD, Hanscom B, Tosteson AN, Blood EA, Birkmeyer NJ, Hilibrand AS, Herkowitz H, Cammisa FP, Albert TJ, Emery SE, Lenke LG, Abdu WA, Longley M, Errico TJ, Hu SS. Surgical versus nonsurgical treatment for lumbar degenerative spondylolisthesis. N Engl J Med 2007 May 31;356(22):2257-70.

Wilson CT, Fisher ES, Welch HG, Siewers AE, Lucas FL. U.S. trends in CABG hospital volume: the effect of adding cardiac surgery programs. Health Affairs 2007 Jan-Feb;26(1):162-8.

Stukel TA, Fisher ES, Wennberg DE, Alter DA, Gottlieb DJ, Vermeulen MJ. Analysis of Observational Studies in the Presence of Treatment Selection Bias: Effects of Invasive Cardiac Management on AMI Survival Using Propensity Score and Instrumental Variable Methods. JAMA 2007;297:278-285.

2006
Weinstein JN, Tosteson TD, Lurie JD, Tosteson AN, Hanscom B, Skinner JS, Abdu WA, Hilibrand AS, Boden SD, Deyo RA. Surgical vs Nonoperative Treatment for Lumbar Disk Herniation: The Spine Patient Outcomes Research Trial (SPORT): A Randomized Trial. JAMA 2006;296:2441-2450.

Weinstein JN, Lurie JD, Tosteson TD, Skinner JS, Hanscom B, Tosteson AN, Herkowitz H, Fischgrund J, Cammisa FP, Albert T, Deyo RA. Surgical vs Nonoperative Treatment for Lumbar Disk Herniation: The Spine Patient Outcomes Research Trial (SPORT) Observational Cohort. JAMA 2006;296:2451-2459.

Goodman DC, Klerman LV, Johnson KA, Chang CH, Marth N. Geographic Access to Family Planning Facilities and the Risk of Unintended and Teenage Pregnancy. Matern Child Health J 2006 Nov 28.

Weinstein JN, Lurie JD, Olson PR, Bronner KK, Fisher ES. United States' trends and regional variations in lumbar spine surgery: 1992-2003. Spine 2006;31(23):2707-14.

Fisher ES. Paying for performance -- risks and recommendations. N Engl J Med 2006 Nov 2;355(18):1845-7.

Davies L, Welch HG. Epidemiology of head and neck cancer in the United States. Otolaryngol Head Neck Surg 2006 Sep;135(3):451-7.

Weeks WB, Bott DM, Bazos DA, Campbell SL, Lombardo R, Racz MJ, Hannan EL, Wright SM, Fisher ES. Veterans Health Administration patients' use of the private sector for coronary revascularization in New York: Opportunities to improve outcomes by directing care to high-performance hospitals. Med Care 2006 Jun;44(6):519-26.

Chan L, Hart LG, Goodman DC. Geographic access to health care for rural Medicare beneficiaries. J Rural Health 2006 Spring;22(2):140-6.

Sirovich BE, Gottlieb DJ, Welch HG, Fisher ES. Regional variations in health care intensity and physician perceptions of quality of care. Ann Intern Med 2006;144:641-649.

Davies L, Welch HG. Increasing Incidence of Thyroid Cancer in the United States, 1973-2002. JAMA 2006;295:2164-2167.

2005
Teno JM, Mor V, Ward N, Roy J, Clarridge B, Wennberg JE, Fisher ES. Bereaved family member perceptions of quality of end-of-life care in U.S. regions with high and low usage of intensive care unit care. J Am Geriatr Soc. 2005 Nov;53(11):1905-11.

Thompson LA, Goodman DC, Chang CH, Stukel TA. Regional variation in rates of low birth weight. Pediatrics. 2005 Nov;116(5):1114-21.

Schwartz LM, Woloshin S, Birkmeyer JD. How do elderly patients decide where to go for major surgery? Telephone interview survey. BMJ 2005 Oct 8;331(7520):821.

Sirovich BE, Gottlieb DJ, Welch HG, Fisher ES. Variation in the tendency of primary care physicians to intervene. Arch Intern Med. 2005;165:2252-2256.

Skinner J, Chandra A, Staiger D, Lee J, McClellan M. Mortality after acute myocardial infarction in hospitals that disproportionately treat black patients. Circulation. 2005;112:2634-2641.

Jha AK, Fisher ES, Li Z, Orav EJ, Epstein AM. Racial trends in the use of major procedures among the elderly. N Engl J Med. 2005 Aug 18;353(7):683-91.

Baicker K, Chandra A, Skinner J. Geographic variation and the problem of measuring racial disparities in health care. Perspectives in Biology and Medicine. 48.1 (2005) S42-S53.

Welch HG, Schwartz LM, Woloshin S. Prostate-specific antigen levels in the United States: implications of various definitions for abnormal. J Natl Cancer Inst 2005 Aug 3;97(15):1132-7.

Malenka DJ, Kaplan AV, Sharp SM, Wennberg JE. Postmarketing surveillance of medical devices using Medicare claims. Health Affairs. 2005 Jul-Aug;24(4):928-37.

Cull WL, Chang CH, Goodman DC. Where do graduating pediatric residents seek practice positions? Ambul Pediatr. 2005 Jul-Aug;5(4):228-34.

Goodman DC, Committee on Pediatric Workforce. The Pediatrician Workforce: Current Status and Future Prospects. Pediatrics 2005 Jul;116(1):e156-73.

Chandra A, Nundy S, Seabury SA. The growth of physician medical malpractice payments: Evidence from the National Practitioner Data Bank. Health Affairs web exclusive, 31 May 2005; 10.1377/hlthaff.w5.240.

Larson RJ, Woloshin S, Schwartz LM, Welch HG. Celebrity endorsements of cancer screening. J Natl Cancer Inst 2005 May 4;97(9):693-5.

Barnato AE, Lucas FL, Staiger D, Wennberg DE, Chandra A. Hospital-level racial disparities in acute myocardial infarction treatment and outcomes. Med Care. 2005 Apr;43(4):308-19.

Stukel TA, Lucas FL, Wennberg DE. Long-term outcomes of regional variations in intensity of invasive vs. medical management of Medicare patients with acute myocardial infarction. JAMA. 2005 Mar 16;293(11):1329-37.

Larson RJ, Schwartz LM, Woloshin S, Welch HG. Advertising by academic medical centers. Arch Intern Med. 2005 Mar 28;165(6):645-51.

2004
Wennberg DE, Lucas FL, Siewers AE, Kellett MA, Malenka DJ. Outcomes of percutaneous coronary interventions performed at centers without and with onsite coronary artery bypass graft surgery. JAMA. 2004 Oct 27;292(16):1961-8.

Baicker K, Chandra A, Skinner J, Wennberg JE. Who you are and where you live: How race and geography affect the treatment of Medicare beneficiaries. Health Affairs web exclusive, 7 Oct 2004; 10.1377/hlthaff.var.33.

Dimick JB, Finlayson SR, Birkmeyer JD. Regional availability of high-volume hospitals for major surgery. Health Affairs web exclusive, 7 Oct 2004; 10.1377/hlthaff.var.45.

Weinstein JN, Bronner KK, Morgan TS, Wennberg, JE. Trends and geographic variations in major surgery for degenerative diseases of the hip, knee, and spine. Health Affairs web exclusive, 7 Oct 2004; 10.1377/hlthaff.var.81.

Wennberg JE, Peters PG Jr. Unwarranted variations in the quality of health care: can the law help medicine provide a remedy/remedies? Spec Law Dig Health Care Law 2004 Sep;(305):9-25.

Baicker K, Chandra A. Medicare spending, the physician workforce, and beneficiaries' quality of care. Health Affairs web exclusive, 7 April 2004; 10.1377/hlthaff.w4.184.

2003
Wennberg DE, Wennberg JE. Addressing variations: Is there hope for the future? Health Affairs web exclusive, 10 December 2003; 10.1377/hlthaff.w3.614.

Birkmeyer JD. Invited commentary: is it a mistake to focus on errors? Surgery. 2003 Jun;133(6):622-3.

O'Connor AM, Mulley AG, Wennberg JE. Standard consultations are not enough to ensure decision quality regarding preference-sensitive options. Journal of the National Cancer Institute. 95(8):570-1, April 16, 2003.

Fisher ES, Wennberg JE. Health care quality, geographic variations, and the challenge of supply-sensitive care. Perspectives in Biology and Medicine. 46(1):69-79, 2003 Winter.

Finlayson EV, Birkmeyer JD. Effects of hospital volume on life expectancy after selected cancer operations in older adults: A decision analysis. J Am Coll Surg. 2003 Mar;196(3):410-7.

Finlayson SR, Birkmeyer JD. Laycock WS. Trends in surgery for gastroesophageal reflux disease: The effect of laparoscopic surgery on utilization. Surgery. 2003 Feb;133(2):147-53.

Goodman DC, Mick SS, Bott D, Stukel TA, Chang CH, Marth N, Poage J, Carretta HJ. Primary care service areas: A new tool for the evaluation of primary care services. Health Serv Res. 2003 Feb;38:287-309.

Birkmeyer JD, Liu JY. Decision analysis models: Opening the black box. Surgery. 2003 Jan;133(1):1-4.

Goodney PP, Lucas FL, Birkmeyer JD. Should volume standards for cardiovascular surgery focus only on high-risk patients? Circulation. 107(3):384-7, 2003 Jan 28.

Liu JY, Finlayson SR, Laycock WS, Rothstein RI, Trus TL, Pohl H, Birkmeyer JD. Determining an appropriate threshold for referral to surgery for gastroesophageal reflux disease. Surgery. 2003 Jan;133(1):5-12.

2002
Pope GD. Birkmeyer JD. Finlayson SR. National trends in utilization and in-hospital outcomes of bariatric surgery. J Gastrointest Surg. 2002 Nov-Dec;6(6):855-60; discussion 861.

Finlayson EV. Birkmeyer JD. Stukel TA. Siewers AE. Lucas FL. Wennberg DE. Adjusting surgical mortality rates for patient comorbidities: More harm than good? Surgery. 2002 Nov;132(5):787-94.

Wennberg JE. Unwarranted variations in healthcare delivery: Implications for academic medical centres. BMJ. 2002;325:961-964 (26 October).

Wennberg JE. Fisher ES. Finding high quality, efficient providers for value purchasing: Cohort methods better than methods based on events. Med Care. 2002 Oct;40(10):853-5.

Goodney PP. Birkmeyer CM. Birkmeyer JD. Short-term outcomes of laparoscopic and open ventral hernia repair: A meta-analysis. Archives of Surgery. Arch Surg. 2002;137:1161-1165.

Lu-Yao G, Albertsen PC, Stanford JL, Stukel TA, Walker-Corkery ES, Barry MJ. Natural experiment examining impact of aggressive screening and treatment on prostate cancer mortality in two fixed cohorts from Seattle area and Connecticut. BMJ. 2002;325:740 (5 October).

Birkmeyer JD, Skinner JS, Wennberg DE. Will volume-based referral strategies reduce costs or just save lives? Health Affairs. 21(5):234-41, 2002 Sep-Oct.

Goodney PP, Siewers AE, Stukel TA, Lucas FL, Wennberg DE, Birkmeyer JD. Is surgery getting safer? National trends in operative mortality. J Am Coll Surg. 2002 Aug;195(2):219-27.

2001
Fuchs V, McClellan M, Skinner J. Area differences in utilization of medical care and mortality among U.S. elderly. NBER Working Paper No. 8628, December 2001.

Axelrod DA, Fendrick AM, Birkmeyer JD, Wennberg DE, Siewers AE. Cardiologists performing peripheral angioplasties: Impact on utilization. Eff Clin Pract. September/October 2001.

Birkmeyer JD. Primer on geographic variation in health care. Eff Clin Pract. September/October 2001.

Birkmeyer JD, Finlayson EV, Birkmeyer CM. Volume standards in high risk surgery: Potential benefits of the Leapfrog initiative. Surgery. 2001 Sep;130(3):415-22.

Goodman DC, Fisher ES, Little GA, Stukel TA, Chang CH. The uneven landscape of newborn intensive care services: Variation in the neonatology workforce. Eff Clin Pract. July/August 2001.

Finlayson EV, Birkmeyer JD. Operative mortality with elective surgery in older adults. Eff Clin Pract. July/August 2001.

Skinner J, Fisher ES, Wennberg JE. The efficiency of Medicare. NBER Working Paper No. 8395, July 2001.

Birkmeyer JD, Hamby L, Birkmeyer CM, Ryder L, Dow RW. Is unplanned reoperation a useful quality indicator in general surgery? Arch Surg. 2001 (April);136(4):405-10.

Lurie JD, Weinstein JN. Shared decision-making and the orthopaedic workforce. Clin Orthop Relat Res. 2001 Apr;(385):68-75.

2000 and earlier
Skinner J, Wennberg JE. How much is enough? Efficiency and Medicare spending in the last six months of life. In The Changing Hospital Industry: Comparing Not-for-Profit and For-Profit Institutions. Cutler, D.M., pp. 169-193, (Chicago: The University of Chicago, 2000).

Feenberg D, Skinner J.Federal Medicare transfers across states: Winners and losers. National Tax Journal. Vol. LIII, No. 3, Part 2.

Onel E, Hammond CS, Wasson JH, Berlin BB et al.An assessment of the feasibility and impact of shared decision-making in prostate cancer. Urology. 1998 Jan;51(1):63-6.

Wennberg JE, Fowler FJ.A test of consumer contribution to small area variations in health care delivery. J Maine Medical Assoc. Vol. 68, No. 8, Pages 275-279.

Wennberg JE, Gittelsohn A.Health care delivery in Maine I: Patterns of use of common surgical procedures. J Maine Medical Assoc. Vol. 66, No. 5, Pages 123-130, 149.

Wennberg JE, Gittelsohn A, Soule D.Health care delivery in Maine II: Conditions explaining hospital admission. J Maine Medical Assoc. Vol. 66, No. 10, Pages 255-261, 269.

Wennberg JE, Gittelsohn A, Shapiro N.Health care delivery in Maine III: Evaluating the level of hospital performance. J Maine Medical Assoc. Vol. 66, No. 11, Pages 298-306.

Wennberg JE. Excerpt from: Dealing with medical practice variations: A proposal for action. Health Affairs. 1984;3(2):6-32.