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--Currently working on revising this--

Draft of new version to update the existing entry for The Dartmouth Institute for Health Policy and Clinical Practice:

Impact on Health Care

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The Dartmouth Institute for Health Policy and Clinical Practice is a health sciences research and education institute at Dartmouth College. Among its 30 years of accomplishments, it has established a new discipline and educational focus in health care delivery science, introduced and advanced the concept of shared decision-making for patients, demonstrated unwarranted variation in the practice and outcomes of medical treatment, and shown that more health care is not necessarily better care.[1] The current research portfolio of Dartmouth Institute faculty and researchers includes developing the concept of shared decision-making between patients and health care professionals[2], creating the model for accountable care organizations (ACOs)[3][4], and introducing concepts of “over-diagnosis” and “over-treatment.” [5][6] The Dartmouth Institute also publishes The Dartmouth Atlas of Health Care, a series of reports that use Medicare data to examine variation in the supply and delivery of care across the U.S.[7] These reports have been used by policymakers, the media, health care analysts and others to assess how the U.S. health care system functions and how patient populations actually experience health care.[8][9] Health care reform legislation at both the federal and state levels has had its roots in The Dartmouth Institute’s research, including the Affordable Care Act[10][11][3] and a Vermont law (Act 128) aimed at achieving universal health care in the state.[12] The Dartmouth Institute works with local, regional, national and international partners to advance health care delivery, including but not limited to ReThink Health[13], the High Value Health Collaborative[14], Dartmouth-Hitchcock Medical Center[15] and the King’s Fund[16]. The Institute is part of Dartmouth College’s Geisel School of Medicine and is housed in Lebanon, New Hampshire.

History

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The Dartmouth Institute was founded in 1988 by John E. “Jack” Wennberg as the Center for Evaluative Clinical Sciences (CECS). Dr. Wennberg has examined variation in health care resource distribution in the United States for more than 40 years. Beginning with his first article, published in Science Magazine in 1973, Dr. Wennberg’s work revealed unwarranted variation in health care.[17] Unwarranted or geographic variations are differences unexplained by illness, medical need, or the dictates of evidence-based medicine. The first Dartmouth Atlas of Health Care report on unwarranted variation was published in the 1990s.[18] In 2007, CECS was reorganized as The Dartmouth Institute for Health Policy and Clinical Practice with James N. Weinstein succeeding Jack Wennberg as director. Elliott S. Fisher, MD, MPH, was appointed the Institute’s third director in 2013. Dr. Fisher and colleagues developed the concept of accountable care organizations (ACOs) and carried out the research that led to their inclusion in the Affordable Care Act.[19][10][11][3] In 2015, The Center for Health Care Delivery Science at Dartmouth merged with The Dartmouth Institute.[20] 

Educational Programs

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The Dartmouth Institute for Health Policy and Clinical Practice offers several professional and graduate education programs, including a Master of Public Health (MPH)[21], a Master of Science in Healthcare Research[21], a Master of Health Care Delivery Science offered in conjunction with the Tuck School of Business Administration at Dartmouth[22], and a Doctor of Philosophy in health policy and clinical practice.[21]

Research Programs

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Center for Healthcare Innovation Research in Progress (CHIRP)

In September 2015 The Dartmouth Institute, in collaboration with Harvard, Berkeley and the High Value Health Care Collaborative, was named one of three National Centers of Excellence by the Agency for Healthcare Research and Quality (AHRQ), and formed the Center for Healthcare Innovation Research in Progress.[23][24] CHIRP researchers are investigating how healthcare organizations adopt and spread a variety of evidence-based innovations.[24]

Comparative Effectiveness Research

Research in Comparative Effectiveness at the Institute includes understanding how medical technologies and innovations in health care delivery affect clinical care and outcomes for patients and whether such advances are are actually improving prevention, diagnosis and treatment of illness. [25][26][27] In addition, Institute scientists are developing methodological approaches to determine whether certain interventions are cost-effective.[28]

Patient Engagement Research

The Institute’s patient engagement research focuses on shared decision making and informed patient choice.[29] Led by Glyn Elwyn this group is developing tools and interventions such as Option Grids[30] to facilitate shared decision making.[31]

References

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  1. ^ "WHO | Dartmouth Institute for Health Policy and Clinical Practice, USA". www.who.int. Retrieved 2016-05-27.
  2. ^ webadmin (2013-04-24). "Renewed Interest In Shared Decision Making". www.managedcaremag.com. Retrieved 2016-05-03.
  3. ^ a b c "The History and Definition of the 'Accountable Care Organization'". October 2010.
  4. ^ Fisher, Elliott S.; Staiger, Douglas O.; Bynum, Julie P.W.; Gottlieb, Daniel J. (January 2007). "Creating Accountable Care Organizations: The Extended Hospital Medical Staff". Health Affairs.
  5. ^ Welch, H. Gilbert (2012-02-27). "Overdiagnosis as a Flaw in Health Care". The New York Times. ISSN 0362-4331. Retrieved 2016-03-30.
  6. ^ "Protect yourself from overtreatment". Center for Medical Consumers. 2011-03-07. Retrieved 2016-05-03.
  7. ^ "Dartmouth Atlas of Health Care". www.dartmouthatlas.org. Retrieved 2016-05-04.
  8. ^ Review-Journal, Jennifer Robison Las Vegas. "How Nevada deals with end-of-life spending". Las Vegas Review-Journal. Retrieved 2016-03-30.
  9. ^ "Report shows disparities in U.S. diabetes prevention, amputation". Reuters. 2014-10-14. Retrieved 2016-05-04.
  10. ^ a b Johnson, Avery (2011-03-28). "The Model of the Future?". Wall Street Journal. ISSN 0099-9660. Retrieved 2016-05-04.
  11. ^ a b "The Patient Protection and Affordable Care Act" (PDF). Public Law 111–148, 111th Congress. March 23, 2010.
  12. ^ "Act 128 , Health System Reform Design" (PDF). Achieving Affordable Universal Health Care in Vermont. February 17, 2011.
  13. ^ "The Pioneers | ReThink Health". www.rethinkhealth.org. Retrieved 2016-05-04.
  14. ^ "Members | High Value Healthcare Collaborative". High Value Healthcare Collaborative. Retrieved 2016-05-04.
  15. ^ "The Dartmouth Institute for Health Policy and Clinical Practice | Leadership Preventive Medicine Residency | Residents & Fellows | Dartmouth-Hitchcock". gme.dartmouth-hitchcock.org. Retrieved 2016-05-04.
  16. ^ "Jack Wennberg: unwarranted variations in medical practice; lessons from the USA". The King's Fund. Retrieved 2016-05-04.
  17. ^ Wennberg, J.; Gittelsohn, null (1973-12-14). "Small area variations in health care delivery". Science (New York, N.Y.). 182 (4117): 1102–1108. ISSN 0036-8075. PMID 4750608.
  18. ^ Welch, H. Gilbert (October 15, 2013). "Discovering the epidemic of overtreatment". Los Angeles Times.
  19. ^ Punke, Molly Gamble and Heather. "ACO Manifesto: 50 Things to Know About Accountable Care Organizations". www.beckershospitalreview.com. Retrieved 2016-03-30.
  20. ^ "Dartmouth Combines Two Health Care Programs". Dartmouth Now.
  21. ^ a b c "The Dartmouth Institute MPH, MS, and PhD Programs". www.gradschools.com. Retrieved 2016-05-04.
  22. ^ "Dartmouth Launches New Degree Program in Health Care Delivery Science". The Health Care Blog.
  23. ^ "PCOR Grant Awards". www.ahrq.gov. Retrieved 2016-03-30.
  24. ^ a b "CHIRP: AHRQ National Center of Excellence – CHOIR". choir.berkeley.edu. Retrieved 2016-05-19.
  25. ^ Tan, Anna (2014-12-15). "Additional Ultrasound Breast Cancer Screening Not Effective in Women with Dense Breast Tissue". Breast Cancer News.
  26. ^ Tosteson, Anna N. A.; Tosteson, Tor D.; Lurie, Jon D.; Abdu, William; Herkowitz, Harry; Andersson, Gunnar; Albert, Todd; Bridwell, Keith; Zhao, Wenyan (2011-11-15). "Comparative effectiveness evidence from the spine patient outcomes research trial: surgical versus nonoperative care for spinal stenosis, degenerative spondylolisthesis, and intervertebral disc herniation". Spine. 36 (24): 2061–2068. doi:10.1097/BRS.0b013e318235457b. ISSN 1528-1159. PMC 3472956. PMID 22048651.
  27. ^ "Called Back After A Mammogram? Doctors Are Trying To Make It Less Scary". NPR.org. Retrieved 2016-03-30.
  28. ^ Tosteson, A. N.; Weinstein, M. C.; Hunink, M. G.; Mittleman, M. A.; Williams, L. W.; Goldman, P. A.; Goldman, L. (1997-01-07). "Cost-effectiveness of populationwide educational approaches to reduce serum cholesterol levels". Circulation. 95 (1): 24–30. ISSN 0009-7322. PMID 8994412.
  29. ^ Stevens, Gabrielle; Miller, Yvette D.; Watson, Bernadette; Thompson, Rachel (2016-06-01). "Choosing a Model of Maternity Care: Decision Support Needs of Australian Women". Birth. 43 (2): 167–175. doi:10.1111/birt.12212. ISSN 1523-536X.
  30. ^ Elwyn, Glyn; Lloyd, Amy; Joseph-Williams, Natalie; Cording, Emma; Thomson, Richard; Durand, Marie-Anne; Edwards, Adrian. "Option Grids: Shared decision making made easier". Patient Education and Counseling. 90 (2): 207–212. doi:10.1016/j.pec.2012.06.036.
  31. ^ Gorman, Anna. "Letting Patients Call the Shots". The Atlantic. Retrieved 2016-05-19.
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