The Dartmouth Atlas of Health Care

This year's volume of the Anthology features two chapters that examine the Foundation's efforts to improve the quality of medical care. In Chapter 3, Irene Wielawski looks at the chronic care model, a systematic way of treating patients with chronic conditions. In this chapter, Carolyn Newbergh, a freelance writer specializing in health care, discusses The Dartmouth Atlas of Health Care and the other work of Jack Wennberg, M.D., highlighting the capricious way that patients receive medical care depending on where they live.

Wennberg and his colleagues at the Center for Evaluative Clinical Sciences at Dartmouth Medical School have demonstrated that physicians in many communities are providing too much care that has little, if any, impact on health, and may even be harmful. They make the case that the health care system could save a considerable amount of money without sacrificing quality if excessive and unnecessary care were eliminated. At the same time, they have shown that many physicians do not deliver the kinds of basic care that are known to be beneficial to patients.

While Wennberg's work on variation of health care has been widely recognized by health policy experts, it has had little influence on medical practice. The same is true of the chronic care model discussed in Irene Wielawski's chapter. This lack of acceptance points up the challenge of changing behavior and systems in ways that will provide high-quality care to patients and allocate limited health care resources wisely.

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