This article has multiple issues. Please help improve it or discuss these issues on the talk page . (Learn how and when to remove these template messages)(Learn how and when to remove this template message)
The Dartmouth Institute for Health Policy and Clinical Practice (TDI) is an organization within Dartmouth College "dedicated to improving health care through education, research, policy reform, leadership improvement, and communication with patients and the public."It was founded in 1988 by John Wennberg as the Center for the Evaluative Clinical Sciences (CECS); a reorganization in 2007 led to TDI's current structure.
The institute provides a graduate-level education program involving elements of both Dartmouth's Graduate Arts and Sciences Programs and the Geisel School of Medicine. It grants Masters in Public Health degrees as well as Master of Science and Doctor of Philosophy in Health Policy and Clinical Science degrees. The institute is located at One Medical Center Drive, WTRB, Level 5 on the Dartmouth Hitchcock Hospital campus, Lebanon, NH. The institute's largest policy product is the Dartmouth Atlas of Health Care,which documents unwarranted variation in the American health care system.
Dr. Anna Tosteson has served as interim director since October 2018, when former director Elliott S. Fisher and chief of strategy Adam Keller were placed on paid administrative leave following a complaint about conduct in the workplace. The investigation into misconduct concluded in April 2019 and resulted in Fisher's demotion and Keller's resignation.This followed the resignation of Professor H. Gilbert Welch in 2018 after Dartmouth College concluded he committed plagiarism. As a condition of his return directly set by the Geisel School of Medicine, Fisher has been banned physically from the 5th floor of the Williamson Building, where most of TDI is housed, for a period of two years.
The Geisel School of Medicine is the medical school of Dartmouth College, an Ivy League research university located in Hanover, New Hampshire, United States. The fourth-oldest medical school in the United States, it was founded in 1797 by New England physician Nathan Smith and grew steadily over the course of the 19th century. Several milestones in medical care and research have taken place at Dartmouth, including the first clinical X-ray (1896), the first intensive care unit in the United States (1955), and the Brattleboro rat (1961).
Ira Robert Byock is an American physician, author, and advocate for palliative care. He is founder and chief medical officer of the Providence St. Joseph Health Institute for Human Caring in Torrance, California, and holds appointments as active emeritus professor of medicine and professor of community health and family medicine at the Geisel School of Medicine at Dartmouth. He was director of palliative medicine at Dartmouth–Hitchcock Medical Center, from 2003–14, and associate director for patient and family-centered care at the affiliated Norris-Cotton Cancer Center.
Health Dialog is a care management, employee wellness, and decision support provider, and wholly owned subsidiary of Rite Aid Corporation. The company is based in the United States and headquartered in Boston, Massachusetts. The company was founded in 1997 to address overutilization. Research done by John Wennberg and The Dartmouth Institute for Health Policy and Clinical Practice found unwarranted variation, which means that the amount of healthcare services consumed per capita varies significantly between different regions of the United States, and that areas that deliver more care or higher-cost care do not necessarily show improvements in health quality outcomes. The company seeks to reduce unwarranted variation in the U.S. healthcare system through care management and shared decision making.
John E. "Jack" Wennberg is the pioneer and leading researcher of unwarranted variation in the healthcare industry. In four decades of work, Wennberg has documented the geographic variation in the healthcare that patients receive in the United States. In 1988, he founded the Center for the Evaluative Clinical Sciences at Dartmouth Medical School to address that unwarranted variation in healthcare.
Unwarranted variation in health care service delivery refers to medical practice pattern variation that cannot be explained by illness, medical need, or the dictates of evidence-based medicine. It is one of the causes of low value care often ignored by health systems.
Donald M. Berwick is a former Administrator of the Centers for Medicare and Medicaid Services (CMS). Prior to his work in the administration, he was President and Chief Executive Officer of the Institute for Healthcare Improvement a not-for-profit organization.
Healthcare reform in the United States has a long history. Reforms have often been proposed but have rarely been accomplished. In 2010, landmark reform was passed through two federal statutes enacted in 2010: the Patient Protection and Affordable Care Act (PPACA), signed March 23, 2010, and the Health Care and Education Reconciliation Act of 2010, which amended the PPACA and became law on March 30, 2010.
In economics, supplier induced demand (SID) may occur when asymmetry of information exists between supplier and consumer. The supplier can use superior information to encourage an individual to demand a greater quantity of the good or service they supply than the Pareto efficient level, should asymmetric information not exist. The result of this is a welfare loss.
Outcomes research is a branch of public health research, which studies the end results (outcomes) of the structure and processes of the health care system on the health and well-being of patients and populations. According to one medical outcomes and guidelines source book - 1996, Outcomes research includes health services research that focuses on identifying variations in medical procedures and associated health outcomes. Though listed as a synonym for the National Library of Medicine MeSH term "Outcome Assessment ", outcomes research may refer to both health services research and healthcare outcomes assessment, which aims at Health technology assessment, decision making, and policy analysis through systematic evaluation of quality of care, access, and effectiveness.
Comparative effectiveness research (CER) is the direct comparison of existing health care interventions to determine which work best for which patients and which pose the greatest benefits and harms. The core question of comparative effectiveness research is which treatment works best, for whom, and under what circumstances. Engaging various stakeholders in this process, while difficult, makes research more applicable through providing information that improves patient decision making.
Albert Siu is an internist and geriatrician and the Ellen and Howard C. Katz Chairman and Professor of the Brookdale Department of Geriatrics and Palliative Medicine at Mount Sinai Hospital in New York City. He is also the director of the Geriatric Research, Education, and Clinical Center at the James J. Peters VA Medical Center in The Bronx, a senior associate editor of Health Services Research, a senior fellow of the Brookdale Foundation and a former trustee of the Nathan Cummings Foundation.
Health care in the United States is provided by many distinct organizations. Health care facilities are largely owned and operated by private sector businesses. 58% of community hospitals in the United States are non-profit, 21% are government owned, and 21% are for-profit. According to the World Health Organization (WHO), the United States spent $9,403 on health care per capita, and 17.1% on health care as percentage of its GDP in 2014. Healthcare coverage is provided through a combination of private health insurance and public health coverage. The United States does not have a universal healthcare program, unlike some other countries.
An Accountable Care Organization (ACO) is a healthcare organization that ties provider reimbursements to quality metrics and reductions in the cost of care. ACOs in the United States are formed from a group of coordinated health-care practitioners. They use alternative payment models, normally, capitation. The organization is accountable to patients and third-party payers for the quality, appropriateness and efficiency of the health care provided. According to the Centers for Medicare and Medicaid Services, an ACO is "an organization of health care practitioners that agrees to be accountable for the quality, cost, and overall care of Medicare beneficiaries who are enrolled in the traditional fee-for-service program who are assigned to it".
Unnecessary health care is health care provided with a higher volume or cost than is appropriate. In the United States, where health care costs are the highest as a percentage of GDP, overuse was the predominant factor in its expense, accounting for about a third of its health care spending in 2012.
Karen Davis is president of The Commonwealth Fund, a national philanthropy engaged in independent research on health and social policy issues. Davis is an economist, with a career in public policy and research. Before joining The Commonwealth Fund, she served as chairman of the Department of Health Policy and Management at The Johns Hopkins School of Public Health, where she also held an appointment as professor of economics. She served as deputy assistant secretary for health policy in the Department of Health and Human Services from 1977–1980, becoming the first woman to head a U.S. public health service agency.
Peter B. Bach is a physician, epidemiologist, and writer at Memorial Sloan-Kettering Cancer Center where he is Director of the Center for Health Policy and Outcomes. His research focuses on healthcare policy, particularly as it relates to Medicare, racial disparities in cancer care quality, and lung cancer. Along with his scientific writings he is a frequent contributor to The New York Times and other newspapers.
AllTrials is a project advocating that clinical research adopt the principles of open research. The project summarizes itself as "All trials registered, all results reported": that is, all clinical trials should be listed in a clinical trials registry, and their results should always be shared as open data.
Health policy and management is the field relating to leadership, management, and administration of public health systems, health care systems, hospitals, and hospital networks. Health care administrators are considered health care professionals.
Elliott S. Fisher is a health policy researcher and advocate for improving health system performance in the United States. He helped develop the concept of accountable care organizations and championed their adoption by Medicare. The development of the Affordable Care Act was influenced by his research on disparities in healthcare spending and utilization across the United States. He has strongly supported a rapid transition from fee-for-service to pay-for-performance models in the U.S. healthcare industry. He is a tenured faculty member at Dartmouth College, where he teaches in the Masters in Public Health program. In August 2018, he was placed on paid administrative leave following a complaint about misconduct in the workplace and banned from the college campus. In April 2019, he was removed as director of The Dartmouth Institute for Health Policy and Clinical Practice after an investigation into misconduct in the workplace. He continues to be physically banned from parts of the college campus for a period of two years as a condition of his return to the faculty.
Health care efficiency is a comparison of delivery system outputs, such as physician visits, relative value units, or health outcomes, with inputs like cost, time, or material. Efficiency can be reported then as a ratio of outputs to inputs or a comparison to optimal productivity using stochastic frontier analysis or data envelopment analysis. An alternative approach is to look at latency times and delay times between a care order and completion of work, and stated accomplishment in relation to estimated effort.