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Wennberg first suggested the idea of a health-care atlas in a proposal to the Robert Wood Johnson Foundation. Concerned about the high cost of medical care, the Foundation agreed to fund the project, seeing it as an important step toward understanding the root cause behind inflated costs in the U.S. health-care system. "It's hard to overstate the role of the Robert Wood Johnson Foundation with CECS. They made it possible for this work to be done, and for it to be published," says McAndrew.

Emboldened by the Robert Wood Johnson grant, the Atlas project began in 1993 and the first edition was published three years later. Not only did the Atlas illustrate the extraordinary variations in health-care resources and utilization across the country, but it also disclosed the methodology used to derive that information. "This meant that anyone who wanted to argue with the methodology was dealing with the real thing," explains McAndrew.

And argue they did. The Atlas presented ideas that were not especially welcomed by the medical establishment. Ideas such as that supply increases demand in health care. That areas with more hospitals and specialists spend more on health care per person. And, most


surprising of all, that more health care doesn't necessarily translate into better care, better health, or greater patient satisfaction.

Subsequent editions, all funded by Robert Wood Johnson, grew in breadth and depth—including measures such as Medicare enrollees' experiences in the last six months of life and use of preventive interventions like pneumonia vaccinations.

While the readership for the Atlas is mainly health-care consultants, insurers, and large employers looking to save health-care dollars, CECS believes the information could be useful to a lay

Wennberg suggested the idea of a health-care atlas in a proposal to the Robert Wood Johnson Foundation.

audience. "People are doing a lot more homework on their health," notes McAndrew. "An important goal of Jack's is to get the patients involved in the decision-making process."

To that end, an online Atlas was launched in September 2000—with a grant from Robert Wood Johnson.

The most recent step in its long tradition of generous support to the Atlas project came in July 2004, when the Foundation made a threeyear, $1.5-million grant for the continuation and expansion of the project's analyses. Goals include gaining access to real-time Medicare claims data, introducing provider-specific data, and increasing awareness of the Atlas among all groups, especially consumers.

The partnership between CECS and the Robert Wood Johnson Foundation is making the Dartmouth Atlas an increasingly powerful catalyst in reducing variations and improving the nation's health-care system.

Barbra Alan is assistant director of development communications at DHMC.

Important partners in improving care

Without funding support, landmark research efforts like that of Dr. John Wennberg and his talented colleagues at the Center for the Evaluative Clinical Sciences (CECS) cannot effect the change that is so critically needed in our nation's health-care system.

Funding partners essential to CECS' work in measuring, organizing, and improving the healthcare system include the Robert Wood Johnson Foundation, which believed early on in the importance of Dr. Wennberg's controversial work, and Peggy Y. Thomson, whose late husband, Dr. Andrew Thomson, Jr., endowed the Peggy Y. Thomson Professorship in the Evaluative Clinical Sciences in her honor in 1994. The country's first endowed chair in the discipline of outcomes research, the Thomson Professorship is held by Dr. Wennberg.


The physicians, scientists, and students at CECS are working to define what quality medical care is and how best to provide it. The knowledge they are developing in understanding the systems and processes of care, outcomes research, clinical applications, and the role and value of shared decisionmaking is revolutionizing health care. And their efforts are realigning the resources and incentives of our health-care system, provoking changes that will improve the lives of millions.

The generosity of those who understand and appreciate the innovative work of CECS and who are inspired to support it will help ensure the continuous improvement of health care, and the health-care system, for us all.

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