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Comment on Silber et al.: Investing in Postadmission Survival-A "Failure-to-Rescue" U.S. Population Health

In 1938 Sir Allison Glover presented a paper to the Royal Academy of Medicine in England documenting significant variation between towns in tonsillectomy rates among school children (Glover 1938). By the 1970s regional variation had become the focus of concentrated scientific inquiry in the United States (Wennberg and Gittelsohn 1973) and, in 2009–2010, the center of U.S. health care reform debate. Short of directly implementing payment reforms to reduce variation, Section 1159 of the Affordable Health Care for Americans Act requires that the Institute of Medicine (IOM) conduct a study of geographic variation in volume and intensity of services and health care spending and make recommendations regarding payment reforms based on their findings. Among the decades of research findings that the IOM's committee must integrate in this task is a new study by Jeffrey H. Silber, R. Kaestner, O. Even-Shoshan, Y. Wang, and L. J. Bressler in this Theme Issue of Health Services Research, “Aggressive Treatment Style and Surgical Outcomes” (Silber et al. 2010).



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