Understanding High Value Care and Reducing Unwarranted Variation in Health Care Delivery: A Collaborative Project of the Mayo Clinic, Intermountain Health Care and The Center for the Evaluative Clinical Sciences
Dr. John E. Wennberg presented Medical Grand Rounds at Dartmouth-Hitchcock Medical Center on Friday, February 9, 2007. His presentation focused attention on and described a new project designed to reduce the problems of unwarranted variation and inefficiency in health care. This multi-year, phased project's goals are: to implement "best practice" clinical pathways in order to decrease variation, reduce the cost, and increase the quality of care for patients with chronic illness; to document the actuarial cost of "best practices" for managing chronic disease and shared decision making for high cost/high variation procedures; and to use this information to support new reimbursement models that support high value care. View lecture

Understanding practice patterns: A focus on what the quality movement can do to reduce unwarranted variations
On December 14th, 2005, Dr. Wennberg gave the keynote lecture at the Institute for Healthcare Improvement's National Forum in Orlando, FL. He took the opportunity to provide an update on our efforts to better understand unwarranted variation in health care -- variation that cannot be explained on the basis of illness, patient preferences or the dictates of evidence-based medicine. Slides & lecture

Bending the cost curve: Achieving accountability for quality and costs
Dr. Elliott Fisher presented his perspective on the challenges and opportunities facing state level health care reform efforts as the keynote speaker at an invitational conference chaired by Governor Jim Douglas of Vermont, the "Governor's Health Care Summit", Killington VT, October 17, 2005. View the slides

Variation in use of Medicare services among regions and selected academic medical centers: Is more better?
On January 24, 2005, Dr. Wennberg gave the annual Duncan Clark Lecture at the New York Academy of Medicine. He took the opportunity to provide an update on our efforts to better understand practice variations, particularly variation that is unwarranted because it cannot be explained on the basis of illness, patient preferences or the dictates of evidence-based medicine. Commonwealth Fund Report on lecture

Unwarranted variations and their remedies: Findings from the Dartmouth Atlas of Health Care
The overuse, underuse, and misuse of medical care in the United States. Interventions that are of little value are commonly overused; care that is effective is commonly underused; and care that is of unproved value is frequently misused. Spending on medical interventions continues to increase without evidence that doing more results in better outcomes or better patient satisfaction. Slides & lecture

Windows on Health Care: The Faces of Variations
This hour-long video program discussing the history and importance of variations is available in 15-minute streaming video segments:
      Part 1       Part 3
      Part 2       Part 4

Unwarranted variations in health care delivery: What's going on in Southern California?
This lecture was given by Dr. John Wennberg at the University of California, Irvine Graduate School of Management. It focuses on variations in health care delivery among residents of Southern California hospital referral regions. Watch lecture

The Dartmouth Atlas report: End-of-life care future challenges
This lecture, adapted from an address given by Dr. John Wennberg at the Center to Advance Palliative Care, focuses on the extraordinary statistical variations in the intensity of health care given to Medicare enrollees at the ends of their lives. Slides & lecture

Is more better?
This presentation by Dr. Elliott S. Fisher argues that, if more intense intervention does not improve life expectancy, and if most patients prefer less care when more intensive care is likely to be futile, then we must conclude that large amounts of money are spent on medical interventions that provide no benefit. Slides & lecture

Medicare reform: Improving fairness and efficiency
This presentation by Dr. Jonathan Skinner asks, what are we getting for our investment in the very aggressive care provided to some Medicare enrollees? High levels of spending do not appear to have yielded a discernible improvement in either life expectancy or quality of life. How can Medicare be fixed to improve both efficiency and fairness? Slides & lecture

Shared Decision Making: One Way of Providing Decision Support
This lecture explains how shared decision making techniques and decision aids can help patients who are facing difficult health care decisions. Slides & lecture

Decision Aids for Shared Decision Making
This lecture describes strategies and methods to help involve patients in making health care decisions. Slides & lecture