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Wennberg's landmark research shows that physician practice patterns underlie much of the variation in utilization among hospital markets. In this interview, he says further study of utilization will turn health policy decisions... more
Wennberg's landmark research shows that physician practice patterns underlie much of the variation in utilization among hospital markets. In this interview, he says further study of utilization will turn health policy decisions from cost to issues of volume and quality.
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Among 13 Vermont Hospital Service Areas, tonsillectomy rates decreased over a five-year period. In 1969, the rates in seven areas exceeded the estimated United States national rate; by 1973, the average rate for all areas had declined 46%... more
Among 13 Vermont Hospital Service Areas, tonsillectomy rates decreased over a five-year period. In 1969, the rates in seven areas exceeded the estimated United States national rate; by 1973, the average rate for all areas had declined 46% and only one area remained above the U.S. rate. Much of the change occurred after feedback of data to the Vermont State Medical Society demonstrating 1969 variations. In 12 of the 13 areas, the relationship between feedback and change in clinical practices could not be documented; however, physicians in the area with the highest rate reviewed the indications for tonsillectomy and adopted a second opinion procedure for reviewing candidates for the surgery. The experience suggests that feedback of population-based data on incidence of procedures may be a valuable tool for the peer review process.
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Research Interests: Adolescent, Herniorrhaphy, Hospitals, Humans, Child, and 10 moreFemale, Male, Vermont, Varicose Veins, Hysterectomy, Maine, Aged, Adult, Tonsillectomy, and Hemorrhoids
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Orthopaedists and other physicians in Maine organized the Maine Medical Assessment Foundation to deal with the problem of variations in the rates of hospitalization for orthopaedic conditions. Five musculoskeletal injuries and five... more
Orthopaedists and other physicians in Maine organized the Maine Medical Assessment Foundation to deal with the problem of variations in the rates of hospitalization for orthopaedic conditions. Five musculoskeletal injuries and five orthopaedic procedures were selected for study. The variation in decision-making by orthopaedists was least for fractures of the ankle and fractures of the hip and was greatest for fractures of the forearm, derangement of the knee, and lumbosacral sprain. The rates in an area tended to be consistently high or low for the same treatments. The major reasons for the variations appeared to be related to lack of agreement about optimum treatment. Feedback of data to physicians on variations in patterns of practice reduced the variations.
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Outcomes research is needed to evaluate variations in medical care. When there is more than one reasonable option for treatment, Wennberg points out the need to base decisions on the patient's preferences. A shared decision-making... more
Outcomes research is needed to evaluate variations in medical care. When there is more than one reasonable option for treatment, Wennberg points out the need to base decisions on the patient's preferences. A shared decision-making model requires that patients be informed of their options, and empowered to make real choices. HMOs are presented with this challenge.
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With its emphasis on consumer choice of health plans, the current health care debate neglects a more fundamental crisis: changes in the traditional physician-patient relationship. This paper discusses how this relationship is being... more
With its emphasis on consumer choice of health plans, the current health care debate neglects a more fundamental crisis: changes in the traditional physician-patient relationship. This paper discusses how this relationship is being redefined and what it means for professionals in the future, particularly in the context of managed competition. The paper asserts that the final health reform plan must address flaws in the scientific and ethical basis of clinical practice. It calls for a flexible workforce policy that promotes shared decision making, lifetime learning, professional commitment to improved quality of care, a national evaluation program, and organizations to coordinate these efforts.
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... Since virtually all patients with symptoms of these conditions will seek care and since the stan-dards of practice throughout the United ... Klim McPherson and Peter Clifford devel-oped a statistic for estimating the magnitude of... more
... Since virtually all patients with symptoms of these conditions will seek care and since the stan-dards of practice throughout the United ... Klim McPherson and Peter Clifford devel-oped a statistic for estimating the magnitude of variation that improves upon traditional measures by ...
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