De-adoption and exnovation in the use of carotid revascularization: retrospective cohort study

British Medical Journal
Kimon Bekelis, Jonathan Skinner, Daniel Gottlieb, Philip Goodney

Objective: To determine physician characteristics associated with exnovation (scaling back on use) and de-adoption (abandoning use) of carotid revascularization.

Conclusion: Surgeons with more experience and the lowest share in carotid revascularization practice reduced their use of the procedure the most. These practice factors should be considered in quality improvement efforts when the evidence base evolves away from a specific treatment.

A Population health approach to reducing observational intensity bias in health risk adjustment: cross sectional analysis of insurance claims

British Medical Journal
Wennberg, DE, Sharp SM, Bevaan, G, Skinner JS, Gottlieb D

Per capita medical spending and utilization varies extensively among healthcare regions, as reported in the Dartmouth Atlas of Healthcare, the NHS Atlas of Variation, and the Spanish Atlas of Variability. These variations have raised major concerns about the effectiveness and equitable distribution of healthcare services, and led naturally to an important question: “To what extent can variations be explained by differences in illness of the regions’ populations?”

Use of hospitals, physician visits, and hospice care during last six months of life among cohorts loyal to highly respected hospitals in the United States

British Medical Journal
Wennberg JE, Fisher ES, Stukel TA, Skinner JS, Sharp SM, Bronner K