Tracking Medicine: A Researcher's Quest to Understand Health Care By John E. Wennberg

Abstract

Wennberg is the father of studies of small- and large-area variation in medical practice. His greatest contribution was to use administrative data (initially, hospital discharge data and later, billing data from Medicare) to simply and clearly demonstrate large variations in the use of certain procedures from one town to the next and from one area of the country to another.This book provides an excellent history of the 40-plus years of work by Wennberg and others in this area. I was somewhat surprised by the “we don't get no respect” tone, the oft-repeated message about how difficult it was for his ideas to find traction. After all, Wennberg's first paper on small-area variation was published in Science, followed by a steady stream of publications in JAMA, the New England Journal of Medicine, and other prestigious journals. From relatively early on, the Dartmouth group received substantial and sustained funding for their work from the Robert Wood Johnson Foundation, the federal government, and other sources. An entirely different narrative tone could have evolved from these same events—more celebratory than underappreciated.