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QUALITY: Wennberg’s Dartmouth team shows enormous variation even in the “best hospitals”

More just astonishing research from Wennberg and his team. The latest study shows that whatever the US News and World Report’s ranking of a hospital, some top centers do lots more to a patient close to the end of life than others. In other words the immense practice variation that Wennberg unveiled in the early 1970s continues, even within the elite hospitals in the nation.

And the differences within this elite group are very large. To get a quick summary look at the this AP story. For example, at Mt Sinai in New York LOS was twice that of the Mayo Clinic, while at Cedars-Sinai in Los Angeles, sick patients stayed in the ICU three times as long as at the Mass General in Boston. There’s much more in the full article in Health Affairs. Something is clearly wrong when the best medicine in America is so different from the best medicine in America.

Another article from part of the same Dartmouth group (led by Elliott Fisher, and including Jack’s son David Wennberg) looks at the impact of ICU services in those same elite hospitals on patient outcomes, and it comes up with this pretty stunning conclusion:

Major U.S. AMCs differ dramatically in the overall intensity of services they provide to similar patients. The increased intensity does not appear to be associated with higher quality of care or to result in better survival. Patients in the higher-intensity hospitals simply spend more time in the hospital and intensive care unit (ICU); have more frequent physician visits (especially in the inpatient setting); have more specialists involved in their care; and receive more imaging services, diagnostic testing, and minor (but not major) procedures. The similar results achieved with markedly different levels of resource inputs imply large differences in the longitudinal efficiency of chronic disease care across these hospitals.

Given that they are handing out Nobel prizes at this time of year, is there a more important body of work in economics that has yet to be recognized? In case you wondered, here’s a list of Nobel prize winners in Economics and even though his formal training wasn’t in economics, I think Wennberg would fit right in with this group.

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