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Tracking Medicine: A Researcher's Quest to Understand Health Care 1st Edition

11 customer reviews
ISBN-13: 978-0199731787
ISBN-10: 0199731780
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Editorial Reviews


"There are many books on healthcare reform, health delivery, or systems research, but none that combine the science with practical experience like this one does." --Doody's

"The cost crisis now facing the US health care system urgently calls for more effective control than the new legislation provides. That is why a new book by Dr. John E. Wennberg, Tracking Medicine, is so important and timely." --The New York Review of Books

"Tracking Medicine should be required reading for all health care professionals, and indeed for all who are intrested in truly reforming health care... Highly recommended." --Choice

"The title of this book hints at a personal history:'researcher's quest . . .' Yet, John Wennberg has been the dominant force over several decades in studies to describe and understand American medicine. Thus, this personal narrative is also an excellent summary of our current understanding of US health care." -- American Journal of Epidemiology

About the Author

John E. Wennberg, MD, MPH, is Peggy Y. Thomson Professor (Chair) in the Evaluative Clinical Sciences, and Founder and Director Emeritus of The Dartmouth Institute for Health Policy and Clinical Practice.

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Product Details

  • Hardcover: 344 pages
  • Publisher: Oxford University Press; 1 edition (August 26, 2010)
  • Language: English
  • ISBN-10: 0199731780
  • ISBN-13: 978-0199731787
  • Product Dimensions: 9.8 x 1.1 x 6.1 inches
  • Shipping Weight: 1.4 pounds (View shipping rates and policies)
  • Average Customer Review: 4.8 out of 5 stars  See all reviews (11 customer reviews)
  • Amazon Best Sellers Rank: #608,841 in Books (See Top 100 in Books)

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Most Helpful Customer Reviews

20 of 20 people found the following review helpful By Irene M. Piekarski on September 17, 2010
Format: Hardcover Verified Purchase
Fascinating, well written picture of our health care situation in 2010-- by a researcher who has spent the last 40 years studying it. Like many "new" ideas, his were initially dismissed, then ridiculed as being wrong. But his methods are impeccable and reproducible. What he has found is that the amount of heath care delivered in this country is directly proportional to the supply of health providers available. That's right-- sicker patients don't necessarily get more care--it's not demand, but supply that determines health care use. And more care isn't necessarily better care; high tech medicine isn't risk free.
My dad who was a research physicist would have called this a corollary to Parkinson's Law--"the work expands to meet the time available"-- updated to" the amount of health care delivered expands to meet the resources available."
The last chapter has concrete suggestions for bending this cure, but given our dysfunctional political system and the strength of the medical-industrial complex, it's doubtful we'll live to see any significant change.
At least when the new Health Care Law goes into effect, if we don't increase the number of hospital beds and health care providers and Dr Wennberg is right, the system should be able to absorb the influx of new patients without a decrease in care quality (but not without a lot of screaming).
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9 of 9 people found the following review helpful By Dr. Mark W. Ketterer on May 7, 2011
Format: Hardcover
Read this book too (along with Overtreated) if you want to understand what has gone wrong with American Medicine.

It always a pleasure to hear a brilliant scientist explain his work. But it is also a revelation to hear such a figure explain how he worked his way through the data with a good deal of self observation, willingness to acknowledge mis-steps and point-by-point response to those who try to provide alternative explanations to his results. Wennberg explains the studies done by the Dartmouth Health Atlas Project, how they altered his original beliefs and gradually caused him to recognize the omnipresence of self-delusion in much of the
medical-industrial complex.

Wennberg's original mission was to examine practices across the state of Vermont to make sure that rural areas were receiving the same "excellent" care as those living near academic medical centers. Looking for underserved populations, he developed a map of regions served by various medical centers and began looking at the frequency of various procedures corrected for population size. In one town, 60% of the children had had their tonsils removed by age 15, while in the next town over only 20% of the kids were tonsils free. The odds that a women had had a hysterectomy varied fourfold from region to region. Hospitalization for digestive diseases varied two fold, and for respiratory ailments, threefold. Given the relative homogeneity of the population, these differences in practice patterns made no sense. And death rates, and average age at death, were indistinquishable across regions. Rather than justifying his original concern over undertreatment, Wennberg's data made a strong case for overutilization of dubiously effective procedures favored in the local community.
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8 of 8 people found the following review helpful By James Jaffe on February 19, 2011
Format: Hardcover Verified Purchase
There's a wealth of forceful refutation of conventional wisdom here. American medicine is so expensive because we spend a lot of money 20-30% on stuff that isn't needed. Physician treatment patterns differ by geography but patients in high intensity areas don't fare any better than those in low-intensity areas, tho medicare costs in the latter are half those in former. finally, there's a suggestion that we have a physician surplus rather than shortage. If wennberg's right, and he has a wealth of data so suggesting, most public opinion on this topic is wrong.
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6 of 7 people found the following review helpful By Clancy Hughes on May 5, 2011
Format: Hardcover
Book Review

John Wennberg's book, Tracking Medicine, a researcher's quest to understand health care, challenges anyone interested in health information technology or the Affordable Health Care Act to a `must read.` Wenneberg spent 40 years applying statistical analysis to the care given in various U.S. locations. Wennberg discovered an extreme variation in the manner and quantity of medical services rendered. He applied the science of epidemiology and statistics to understand these differences. What he found was a fundamental contradiction in the patterns of medical practice. These contradictions surprise and shock the medical establishment and others who believed that for healthcare more is better.
Patient satisfaction, outcome and longevity -- even in some teaching centers - proved inversely related to the intensity of medical, surgical and hospital services. Furthermore, Wennberg found that the greater the capacity of the facility and number of specialists per capita, the greater the intensity of care. Intriguingly, he found that providers were completely unaware of this variation. Present day Certificates of Need, required for expanding the number of hospital beds -- and in large measure many other provisions in the Affordable Health Care Act - indeed reflect much of Wennberg's research.
Wennberg together with the Dartmouth Institute of Health Policy and Clinical Practice proposed four policies to improve clinical medicine and quality. They suggested:

1. Organized local systems
2. Decreasing overtreatment by shared decision making between patient and doctor
3. Strengthening the science of health care delivery
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