It’s Not About The Box Improving Care at Group Health with People, Process and Technology

January 13, 2009

The Guru of Clinical Variation visits Group Health

Filed under: Clinical variation,Content of care — Tags: — Matt Handley @ 5:24 pm

Jack Wennberg, the “guru” of small area variation, spent a few days at Group health recently.  He worked with the effort that GHC promoted (and the state sponsored) to promote shared decision making in our wider community, and help us advance the work taht is being sponsored by the Content of Care team in many specialties.

Dr Wennberg is a remarkable doctor and researcher.  He started with some powerfully naive questions in the 70s – why was it that one town, on the east side of a river, had a tonsillectomy rate of 20%, and the town on the other side had an 80% rate?  Were the patients that different?  Years of research have confirmed that while we think of medicine as a profession that is objective and science based, the research that Dr Wennberg and his group have pursued has shown convincingly that it is driven more by local physician culture and “supply” (of doctors, hospital beds, scanners, etc), than it is by clinical circumstance.

A group of clinical opinion leaders from our specialty group had dinner and a conversation with him last week, in advance of our work to systematically introduce the use of clinical decision aids into our practice for a few defined conditions in clinical areas defined as “preference sensitive” care – areas where patient preferences regarding the different outcomes and interventions should drive decision making.  The areas include total hip and knee replacement, management of BPH, management of uterine bleeding and fibroids,  and back surgery.

Some tidbits to check out:

1.  the first study of shared decision making – done at GHC, in men with BPH (published in 1995)

medical care sdm bph study

2.  The Ottawa decision aid for shared decision making (and interactive PDF, and a print version)

ottawa decision aid print

ottawa decision aid interactive

3.  The latest installment of the Dartmouth Atlas, chronicaling the variation in care in the US in the care of patients with chronic illness

2008 dartmouth atlas chronic care

An interesting road ahead, with our specialty group doing what no group in the world has done before – a system wide implementation of shared decision making tools, supported by clinicians.  Here’s to better decision quality, and variation driven only by patient preference and clinical circumstances!

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