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National Health Service History

Geoffrey Rivett

home inheritance1948-19571958-19671968-1977 1978-1987  1988-19971998-2007 2008-2017envoishort history London's hospitals



Dr. John (Jack) E. Wennberg

Jack Wennberg

For more than 40 years, Wennberg has studied and documented striking variations in health care delivery across the United States, concluding that where a patient lives determines the amount of medical care he or she receives. His work is frequently cited as evidence of the lack of a scientific basis for most medical practice. His recent research has focused on ways to document the outcomes, or results, of various medical practices and communicate this information to patients. With his Harvard colleague Dr. Al Mulley he founded the Foundation for Informed Medical Decision Making, an organization that works to promote patient involvement in medical care decisions.  Donald Berwick, cofounder of the Institute for Healthcare Improvement, recently called the CECS work "the most important health service research of the century."

His early work on hysterectomy rates, in the mid-1970s, showed that in the city of Lewiston, an unusually large number of women were having hysterectomies. He projected that if the rate of surgeries continued in Lewiston, 70 percent of its women would have a hysterectomy by age 70.  He decided to collect information about every medical transaction of every person in every town in the whole state of Vermont.  "We needed to know what was going on in home health agencies, what was going on in nursing homes, hospitals, doctors offices," Wennberg says. "And for each patient, what their diagnosis was, what their treatment was, how much money was spent, and what the outcomes were in as far as we could measure them."

To collect these records, Wennberg hired researchers, people dubbed "the pit crew" who year after year were sent out to medical record rooms to collect records. It was a truly massive undertaking to gather every medical transaction in the state of Vermont. It took two years of road trips just to collect the records for 1969.  Wennberg discovered Lewiston's high hysterectomy rate, but he did much more than that. Over the past 40 years, he has completely transformed our understanding of what's going on in health care systems.  He started in Vermont, then moved to Maine, until eventually he studied communities throughout America. Wennberg led us to a clearer understanding of what doctors and hospitals are doing with their patients all across the United States  [www.dartmouthatlas.org]  It was clear that it wasn't that patients were different between regions, so it wasn't the illness that was driving this, this must be coming from the provider side."

His insight:   It was doctors, not patients, who drove medical consumption, and all kinds of things influenced the decisions a doctor makes when a patient enters his office. Sickness and patient preference play an important role, but a much smaller role than patients and the health care community had originally thought.

home inheritance1948-19571958-19671968-1977 1978-1987 1988-1997  1998-2007 2008-2017envoishort history London's hospitals



Geoffrey Rivett©