The Wennberg International Collaborative
The Dartmouth Institute for Health Policy and Clinical Practice
The London School of Economics and Political Science
The Wennberg International Collaborative (WIC) was founded in 2010 to provide a network for investigators actively conducting, or with a high level of interest in, studies of medical practice variation. The WIC has met three times annually in London with steadily greater participation and influence. The Fourth Annual Meeting took place at Dartmouth on October 16-18, 2013, bringing together a diverse group of healthcare researchers and policy analysts from around the world to share their work and participate in discussions with Dartmouth faculty and students.
In the past 40 years, the study of variation of medical care has grown from the early work of Drs. John Wennberg in the United States and Prof. Klim McPherson in the United Kingdom to its current status: a large and growing field of scientific studies and policy analyses that have been instrumental in improving health and health care. While the critical mass of research has occurred in the U.S., U.K., and Canada, there have also been important studies from Switzerland, Italy, Spain, Australia, the Netherlands, and Norway. These studies have focused on the most pressing problems of health care – the need for quality, equity, and efficiency when there is growing tension between providing better health care and the unsustainable growth in expenditures.
Creation of the WIC was prompted by three observations. First, the development of research on health care variation differs tremendously among nations, from a near absence in many countries, to other countries with lone investigators, and a few with a high level of research and policy activity. While some health systems have already benefitted from this type of research, this is the exception rather than the rule. In most places, the work remains in an early stage of development. The WIC is the first “intellectual incubator” to support this field of work.
Second, a search of the past decade of publications suggests that the quality of research methods is uneven. Analyses are often limited by the type of data available and by the difficulties in adjusting for population differences. Investigators attending WIC meetings benefit from learning the most advanced methods of their peers.
Third, many investigators have had difficulty gaining funding and acceptance of their work. This problem has been accentuated by a "backlash" against some investigators or research institutes when the measures of health system performance identify specific geographic areas or health care systems. Learning to manage the need for public transparency while minimizing provider defensiveness increases the practical usefulness of the studies. The WIC shares the strategies and experiences of seasoned Dartmouth researchers with emerging leaders in other countries.
Through its annual meeting and online resources, the WIC network provides a community for investigators to learn, and to reflect on research questions, methods, and practical application. The WIC is singularly focused on advancing this field.
The first three meetings (2010, 2011, 2012) were held at the London School of Economics and Political Science because its venue cost was low and provided easy access for most of the attendees. The 2012 meeting hosted 53 invited attendees from 18 countries, but was forced to turn away a number of those interested because of lack of space and funding. The attendees value the London location and the small meeting size, but also expressed an interest in networking with Dartmouth faculty, and in the participation of additional countries. The 2013 meeting at Dartmouth responded to these needs. The 2014 meeting is expected to return to London with its smaller meeting format.
The 2013 WIC meeting at Dartmouth
The 4th annual meeting was held at Dartmouth College through co-sponsorship of the Geisel School of Medicine, the Dartmouth Institute for Health Policy and Clinical Practice, the Dartmouth Center for Health Care Delivery Science, the Dickey Center, and the London School of Economics.
The conference included a mixture of short research presentations and discussions, and formal longer presentations by leaders in the field, including those from Dartmouth and other U.S. universities and organizations.
Geisel Medical School Dean Chip Souba, MD and John Wennberg, MD gave conference welcome addresses, and keynote speakers included Ms. Susan Dentzer ’77 (editor of Health Affairs and former Chair of the Dartmouth College Board of Trustees), Elliott Fisher, MD (Director of the Dartmouth Institute), and Mr. Chuck Alston, VP MS&L Global (Director of the Dartmouth Atlas communications).
Susan Dentzer and David Goodman co-moderated a late afternoon panel discussion sponsored by the Dickey Center for Dartmouth students, “Health Care Reform in Developed Countries,” which brought together four health policy researchers to discuss that challenges faced by their country’s health care system and the promising solutions to improve care.