Sparked by Dr. John E. Wennberg's early studies of geographic variation in the delivery of health care within the state of Vermont and other New England states, the Outcomes Research and Health Policy section of the the Dartmouth Institute for Health Policy and Clinical Practice has continued to ask critical questions in a number of different areas related to health care. The early work on geographic variation has now expanded to cover the entire United States, and is precisely stated in the Dartmouth Atlas of Health Care publications. Alongside this work, the Institute faculty is studying a number of different areas so as to better question the common wisdom underlying much of the U.S. health care system. One area of study is the benefits and harms of increasingly sensitive diagnostic tests. Another area of study is challenging some fundamental assumptions about the value of health-care spending by asking, "is more necessarily better?" Focusing on the patient aspect of health care delivery, faculty members are looking at better ways to empower the patient in the treatment process through a "shared decision-making" process that allows both the doctor and the patient together determine a treatment process. The faculty at the Institute is instrumental in revealing that forces other than scientific advances and public demand have contributed to the crisis in American health care over the last quarter of the 20th century.

• The Dartmouth Atlas of Health Care
  The Dartmouth Atlas project brings together researchers in diverse disciplines - including epidemiology, economics, and statistics - and focuses on the accurate description of how medical resources are distributed and used in the United States.
  
  
• Primary Care Service Area Project
  The Primary Care Service Area (PCSA) Project is helping to rectify the deficiencies in the existing primary care data infrastructure by creating service areas using nationwide claims data to reflect actual utilization patterns for primary care clinical services.
  
  
• Risk Charts
  If you're a 55 year-old male who has never smoked, how likely is it you will die from heart disease over the next 10 years? From prostate cancer? Pneumonia? Researchers at the Dartmouth Institute for Health Policy and Clinical Practice have created charts to provide patients with information - based on actual records - of their risk of death. The researchers used Census data and records from the National Center for Health Statistics to calculate age- and sex-specific death rates. In addition, they broke out the rates for smokers vs. non-smokers.
  
  
• Drug Facts Boxes
  Advertisements and package inserts for pharmaceutical drugs are full of information on risk factors and side effects, but they have very little data about how well a drug actually works. To help people better understand how a drug helps or harms, TDI researchers have developed the "drug facts box" and are working with the FDA to implement it.
  
  
• Health Services Research Journal
  Health Services Research (HSR) is a peer-reviewed scholarly journal that provides researchers and public and private policymakers with the latest research findings, methods, and concepts related to the financing, organization, delivery, evaluation, and outcomes of health services. Rated as one of the top journals in the fields of health policy and service and healthcare administration, HSR publishes outstanding articles reporting the findings of original investigations that expand knowledge and understating of the wide-ranging field of health care and that will help to improve the health of individuals and communities. Ann Barry Flood, Ph.D., Professor, Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Medical School, Hanover NH, serves as the Co-Editor-in-Chief of the journal.
  
  
• Data Center
  The Data Center provides the investigators and analysts access to federal and private databases that support the Institute's outcomes research initiatives.
  
  
• Is More Health Care Better?
  In much of American medicine, we might have reached the point where providing more interventions actually results in worse outcomes.