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Dealing with medical practice variations: a proposal for action.

Prologue: Without much attention from the profession and virtually no public fanfare, John Wennberg has been tracking the phenomenon of variations in the use of medical care for more than a decade. Wennberg, who ranks among the leaders of the nations tiny cadre of medical care epidemiologists, has been driven by the notion that practice variations were important to identify and understand because they suggest a misuse of care. Wennberg trained at Johns Hopkins University in internal medicine and also holds a master's degree in public health from that institution. Currently, he is a professor in the Department of Community and Family Medicine at Dartmouth Medical School From 1974 to 1979, he served on the faculty of the Harvard Medical School, attached to the Department of Preventive and Social Medicine. During his research pursuits, Wennberg has uncovered systematic and persistent differences in the standardized rates of use for common surgical procedures and other medical services in the United States. B...