BMJ 2002;325:961-964 ( 26 October )

Education and debate

Unwarranted variations in healthcare delivery: implications for academic medical centres

John E Wennberg, director. 

Center for the Evaluative Clinical Sciences, 7251 Strasenburgh, Dartmouth Medical School 03755-3863

john.Wennberg@Dartmouth.edu

The first 150 words of the full text of this article appear below.

Everyday clinical practice is characterised by wide variations that cannot be explained by illness severity or patient preference. Professor Wennberg examines the causes for these variations and suggests ways to remedy the situation

Academic medicine has had only limited success in improving the scientific basis of everyday clinical practice, even within the walls of its own hospitals. Patterns of practice among academic medical centres---as among other institutions---are often idiosyncratic and unscientific, and local medical opinion and local supply of resources are more important than science in determining how medical care is delivered. In short, after nearly 100 years of academic medicine as we know it, much of medicine in the United States remains empirical.

The evaluative clinical sciences---those disciplines whose role in medicine is to evaluate medical theory, understand patient preferences, and improve systems---are capable of improving the scientific basis of clinical practice and warrant high priority . . . [Full text of this article]
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