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>> Elliott Fisher, MD, MPH: You know,
our work here really began thirty years ago
when Jack Wenberg started studying variations in practice
within the State of Vermont.
You know, he looked across identical communities,
demographically identical communities,
and found tenfold differences across Vermont in rates
of surgery for simple procedures, and two
or three fold differences
in per capita spending in these communities.
He then devoted the rest of his career to trying
to understand the causes of those variations in practice
and their implications for public health and public policy,
and many of us joined him in that quest.
>> Adam Keller: What made the Dartmouth Institute distinctive
was this marrying of quantitative research
and [inaudible] knowledge gained from this quantitative research
with this qualitative approach of making change
and making improvement.
>> H. Gilbert Welch, MD, MPH: We've had a long history
of working with large databases trying to see patterns
of how many people use the hospital,
how many people have coronary artery bypass surgery,
how many people are diagnosed with thyroid cancer,
and we're looking across both time and geography to learn
about what's really happening out there.
>> Wayne Moschetti, MD: What I liked about it is that they,
people just didn't talk a big game.
People were [background talk] acting on it.
The health care changes we anticipate in 2014
and moving forward, a lot of those teachings come
from the Dartmouth Institute.
So I think you're around these people who are smart people,
very approachable people, but also who on a global sense
and on a national sense are influencing policy changes.
>> Those are the three areas that I see that -
>> Carrie Colla, PhD: We have a really good group
of multi-disciplinary faculty here.
I think there's a lot more of a focus on the clinical audience
and how things apply to clinical practice.
And so while the [inaudible] environment here is very
intimate, the reach is very broad in terms
of what the policy we're hoping to inform
and the clinical practice we're hoping
to change across the country.
>> H. Gilbert Welch, MD, MPH: [background talk]
In a large sense, our mission is to make things better.
We're watching what's happening
in different parts of the country.
We're watching what's happening in different diseases,
and we're watching what's happening
in different specialties, and we're willing
to make some hard calls, and, and tell people
when things are going on that we don't think [music] serve the
>> Elliott Fisher, MD, MPH: So let's start with -
>> Elliott Fisher, MD, MPH: The reason we use the term
"the science of health care delivery" is
that there is science to everything we do.
We want to have evidence for what are the best practices.
Where we're unsure, we want to test practices
against each other, and we really, you know,
we believe that Dartmouth is at the forefront
of the advanced methods of evaluation that will allow us
to apply science rigorously [background talk]
to what are very difficult and challenging questions,
making sure that knowledge, not guesses,
that knowledge informs change.
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