1973: John E. Wennberg, MD, MPH, published “Small Area Variations Health Care Delivery” in the journal Science, launching the field of research on the causes and consequences of variations in treatment and outcomes. [link]
1984: Dartmouth researchers established that self-care education programs can improve health and healthcare. [link]
1987: Development of COOP Charts improved clinical practice using patient-reported outcome measures [link].
1987: The Northern New England Cardiovascular Disease Study Group, led by Stephen Plume and Gerry O’Connor, established a new model for how clinicians and researchers can implement registry-based improvement.
1988: The Center for the Evaluative Clinical Sciences (CECS) was founded, which is now known at The Dartmouth Institute for Health Policy and Clinical Practice, or TDI.
1988: Dartmouth researchers pioneered the practice of engaging patients in Shared Decision Making (SDM) by providing the scientific rationale for SDM based on sound evidence and attention to patience preferences. “An Assessment of Prostatectomy for Benign Urinary Tract Obstruction,” a multiple article series published in JAMA, described how better information on outcomes, integrated with knowledge of patient preferences, is essential to care improvement.
1989: The US Agency for Health Care Research and Quality (AHRQ) was founded, based largely on Dartmouth and RAND research highlighting the need for better evidence to guide clinical practice.
1991: Professor Paul Batalden was instrumental in the founding of The Institute for Healthcare Improvement (IHI), a globally influential organization dedicated to redesigning healthcare into a system without errors, waste, delays, and unsustainable costs.
1991: A groundbreaking study revealed variations in mortality due to processes of care, not severity of patient illness. “A regional prospective study of in-hospital mortality associated with coronary artery bypass grafting,” was published in JAMA. The findings helped establish the need for registry-based quality improvement programs, now adopted across the world. [link]
1993: Established the nation’s first graduate program in evaluative clinical sciences.
1993: Researchers articulated the harms of overdiagnosis for first time, launching a new field of research. “Advances in Diagnostic Imaging and Overestimations of Disease Prevalence and the Benefits of Therapy” was published in the New England Journal of Medicine. [link]
1996: Published the Dartmouth Atlas of Health Care, the first comprehensive documentation of patterns and variations in US medical practice. [link]
1997: James Weinstein established The Spine Center at Dartmouth Hitchcock to put into practice registry-based improvement for back pain.
2000: Development of a new program for diagnosis and treatment of spine-related problems led to the design and implementation of a new model for delivery of healthcare incorporating outcomes measurement and improvement. This new healthcare delivery model provided, for the first time, clinically meaningful point-of-service data and aggregated information for improvement. [link]
2002: Launched the Master of Public Health program to focus on health quality measurement and organization to improve health in human populations.
2003: The first extensive study of health care variation found that more care is not necessarily better. Published in the Annals of Internal Medicine by Elliott Fisher and others, “The implications of regional variations in Medicare Spending,” demonstrated that regions with higher Medicare spending do not have better quality or outcomes. [link]
2006: Research revealed that physicians practice within natural networks that can form the basis for improvement and payment reform, directly leading to Congress establishing Accountable Care Organizations as a new Medicare payment model. Published in Health Affairs, “Creating Accountable Care Organizations: The Extended Hospital Medical Staff” (Fisher et al.) led to the term Accountable Care Organizations (ACOs) being adopted by the Medicare Payment Advisory Commission (MedPAC) and included in its policy recommendations to Congress. [link]
2007: James Weinstein, MS, DO, succeeded John Wennberg as director of CECS, which was renamed The Dartmouth Institute for Health Policy and Clinical Practice (TDI).
2007: Investigators determined that patients’ preferences for aggressive end-of-life care vary, but these preferences do not explain the large differences in end-of-life care across the US. “Are Regional Variations in End-of-Life Care Intensity Explained by Patient Preferences?” by Amber Barnato and others, was published in Medical Care. [link]
2008: TDI popularized the field of Shared Decision Making with annual summer institutes on informed patient choice.
2008: Findings from a large, randomized trial offered the first, sound, evidence-based guidance for the most common operation for low back pain performed in the US. James Weinstein and others published “Surgical versus Nonsurgical Therapy for Lumbar Spinal Stenosis” in NEJM. [link]
2010: Reports and findings from the Dartmouth Atlas of Health Care were used by the Obama administration to shape the evolution of healthcare and health policy in the US, particularly the Affordable Care Act. The bill included provisions to enact many of the principles articulated in Dartmouth research, including shared decision making, establishing the Patient Centered Outcomes Research Institute, and establishing Accountable Care Organizations as an alternative payment model for Medicare.
2011: TDI and the Tuck School of Business partnered to introduce the Master of Health Care Delivery Sciences program.
2013: Elliott Fisher, MD, MPH, is named Director of TDI.
2013: The inaugural Preventing Overdiagnosis Conference was held at Dartmouth, led by Steven Woloshin and Lisa Schwartz, raising awareness about the harms of overdiagnosis and overtreatment, and to promote strategies to mitigate these issues.
2015: “Coproduction of healthcare service,” published in BMJ Quality & Safety, helped create international recognition of coproduction as a design principle for healthcare service delivery innovation.
2016: TDI researchers articulated a new model for improving health care by combining three elements—learning health systems, coproduction of care with patients, and registries. The model was described in the BMJ: “Patient-focused registries can improve health, care, and science” by Eugene Nelson and others. [link]
2018: Anna N.A. Tosteson, ScD, was named Interim Director of TDI.
2020: The Susan and Richard Levy Health Care Delivery Incubator was launched by TDI and Dartmouth Hitchcock to support the development of innovative healthcare delivery solutions. The Incubator’s primary goal is to provide rapid, scalable, and transformational redesign of health care services. [link]
2020: The Dartmouth Institute and Dartmouth Health launch the Promise Partnership, a learning health system based on principles of coproduction. [link]
2021: Amber Barnato, MD, MPH, MS, is named Director of TDI and Chair of the Department of Health Policy and Clinical Practice.
2022: TDI recruited four new faculty members to investigate and address inequities in healthcare services, outcomes, and patient experiences. The recruitment of these health equity scholars was a key component of the Dartmouth President's commitment to hire BIPOC faculty and faculty who study racial injustice, systemic racism, and institutional equity, marking a deepening commitment to health equity at TDI and across the campus.
2022: TDI introduced the Health Equity Pathways Program to build and support a community of scholars who are dedicated to achieving social justice in health. The program comprises four training opportunities for health equity researchers at various stages of their careers: faculty, pre-doctoral scholars, and undergraduates (the Dartmouth Class of ’74 Scholars). [link]
2022: TDI partnered with We All Count to bring data equity knowledge and practice to the research community at Dartmouth.
2023: TDI adopted a new strategic plan with three primary goals: 1) develop a healthy workplace community, 2) generate impactful research, and 3) support strong education programs. Action-oriented workgroups formed to implement these goals across TDI.
2023: In partnership with the Tuck School of Business, TDI and the Geisel School of Medicine launched the Master of Health Administration degree program.
2024: Professor Carrie Colla returned to Dartmouth to lead the Levy Academic Cluster in Health Economics and Policy after leading the Health Analytics Division of the Congressional Budget Office. She was named the Susan J. and Richard M. Levy Distinguished Professor of Health Policy and Clinical Practice.
2024: TDI hosted its first department-wide Residency, a three-day, on-campus convening designed to build community and academic collaboration within our hybrid workplace.