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Draft:Dartmouth Atlas of Health Care

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The Dartmouth Atlas of Health Care is a research project at the Dartmouth Institute of Health Policy & Clinical Practice (formerly the Center for the Evaluative Clinical Sciences at Dartmouth). Founded in the early 1990s by Dr. John Wennberg and colleagues, the Atlas provides comprehensive data and analysis that examines variations in health care utilization, spending, and quality across different regions[1] and hospitals[2] in the United States. The project aims to provide insight into patterns of health care delivery and outcomes, with the goal of improving health care policy and practice.[3]

Description

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The Atlas uses claims databases, primarily—but not limited to—fee-for-service Medicare,[4] to analyze how medical resources are distributed and used, revealing variations in health care delivery and outcomes that are not always justified by differences in illness burden or patient preferences.[5][6] It examines a wide range of factors, including hospitalizations, procedures, tests, costs, and end-of-life care, among others.[7]

The project's findings have highlighted the substantial differences in health care utilization and spending across the country, as well as the lack of correlation between increased spending and better outcomes.[8][9] It has been influential in the discussion on health care reform and has provided important evidence to help policymakers, the media, health care analysts, and other stakeholders improve their understanding of the efficiency and effectiveness of our health care system.[10][11] These data form the foundation for many of the ongoing efforts to improve health and health systems across America.[12]

With primary support from the Robert Wood Johnson Foundation,[13] the Atlas project has produced more than 60 reports and longitudinal datasets spanning more than 15 years addressing a wide range of issues facing U.S. health care.[14][15]

Criticisms

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The methods used by the Atlas project have received criticism, particularly during the period leading up to the Affordable Care Act, primarily concerned with the project's use of end-of-life patients for risk adjustment.[16][17][18] These critiques received media attention,[19] prompting a back-and-forth exchange with the New York Times,[20][21][22] among other responses.[23] Other researchers argued that regional variations could be explained by poverty, and that policy changes in response to Atlas findings would end up hurting the poor,[24] an argument that was explored by several experts.[25]

Future

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More recently, the Atlas project used county-level data from the New York Times to explore variations during the COVID-19 pandemic[26] and plans a Health Equity Atlas to look at variations in health care utilization and outcomes due to racial and economic inequities.[27]

References

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  1. ^ Kolata, Gina (30 January 1996). "Sharp Regional Incongruity Found in Medical Costs and Treatments". The New York Times.
  2. ^ Winslow, Ron (16 May 2006). "Care Varies Widely At Top Medical Centers". The Wall Street Journal.
  3. ^ Bronner, Kristen; Goodman, David (27 July 2022). "The Dartmouth Atlas of Health Care – bringing health care analyses to health systems, policymakers, and the public". Research in Health Services & Regions. 1 (6): 6. doi:10.1007/s43999-022-00006-2. PMC 9323875. PMID 39177806.
  4. ^ "What is Original Medicare?". MedicareResources.org. 10 August 2023.
  5. ^ Kliff, Sarah (18 September 2014). "How much money do we waste on useless health care?". Vox.
  6. ^ Garber, Judith (3 December 2020). "Medicare spending and low-value care: Lessons from the Dartmouth Atlas and Lown Hospitals Index". Lown Institute.
  7. ^ Anderson, Chris (31 January 2012). "Dartmouth Atlas branches out to pediatric, under-65 care variations". Healthcare Finance News.
  8. ^ Fisher, Elliott; Wennberg, David; Stukel, Therese; Gottlieb, Daniel; Lucas, FL; Pinder, Etoile (18 February 2003). "The implications of regional variations in Medicare spending. Part 1: the content, quality, and accessibility of care". Ann Intern Med. 138 (4): 273–287. doi:10.7326/0003-4819-138-4-200302180-00006. PMID 12585825. S2CID 27581938.
  9. ^ Fisher, Elliott; Wennberg, David; Stukel, Therese; Gottlieb, Daniel; Lucas, FL; Pinder, Etoile (18 February 2003). "The implications of regional variations in Medicare spending. Part 2: health outcomes and satisfaction with care". Ann Intern Med. 138 (4): 288–298. doi:10.7326/0003-4819-138-4-200302180-00007. PMID 12585826. S2CID 8031637.
  10. ^ Mahar, Maggie (Spring 2007). "The State of the Nation's Health". Dartmouth Medicine.
  11. ^ Gawande, Atul (25 May 2009). "The Cost Conundrum". The New Yorker.
  12. ^ Gawande, Atul; Berwick, Donald; Fisher, Elliott; McClellan, Mark (12 August 2009). "10 Steps to Better Health Care". The New York Times.
  13. ^ Isaacs, SL; Knickman, JR (1 January 2007). "To Improve Health and Health Care, Volume X: The Robert Wood Johnson Foundation Anthology". The Robert Wood Johnson Foundation.
  14. ^ The Dartmouth Atlas of Health Care Series. The Dartmouth Institute for Health Policy and Clinical Practice. 1996. {{cite book}}: |website= ignored (help)
  15. ^ "Dartmouth Atlas Dataverse". Dartmouth Dataverse.
  16. ^ McCaughey, Betsy (27 October 2009). "Treating seniors as 'clunkers'". The New York Post.
  17. ^ Ong, Michael; Mangione, Carol; Romano, Patrick; Zhou, Qiong; Auerbach, Andrew; Chun, Alein; Davidson, Bruce; Ganiats, Theodore; Greenfield, Sheldon; Gropper, Michael; Malik, Shaista; Rosenthan, J. Thomas; Escarce, Jose (13 October 2009). "Looking forward, looking back: assessing variations in hospital resource use and outcomes for elderly patients with heart failure". Circ Cardiovasc Qual Outcomes. 2 (6): 548–557. doi:10.1161/CIRCOUTCOMES.108.825612. PMC 2951887. PMID 20031892.
  18. ^ Bach, Peter (18 February 2010). "A Map to Bad Policy — Hospital Efficiency Measures in the Dartmouth Atlas". New England Journal of Medicine. 362 (7): 569–574. doi:10.1056/NEJMp0909947. PMC 3680120. PMID 20164483.
  19. ^ Harris, Gardiner (17 February 2010). "Report Cited by Obama on Hospitals Is Criticized". The New York Times.
  20. ^ Abelson, Reed; Harris, Gardiner (2 June 2010). "Critics Question Study Cited in Health Debate". The New York Times.
  21. ^ Fisher, Elliott; Skinner, Jonathan (7 June 2010). "The Dartmouth Atlas Responds to "Critics Question Study Cited in Health Debate" by Reed Abelson and Gardiner Harris, The New York Times (June 3, 2010)". The New York Times.
  22. ^ Abelson, Reed; Harris, Gardiner (18 June 2010). "Dartmouth Atlas: A Response to Its Researchers". The New York Times.
  23. ^ Skinner, Jonathan; Staiger, Douglas; Fisher, Elliott (18 February 2010). "Looking Back, Moving Forward". New England Journal of Medicine. 362 (7): 569–574. doi:10.1056/NEJMp1000448. PMID 20164482.
  24. ^ Rau, Jordan (16 November 2009). "Crusading Professor Challenges Dartmouth Atlas On Claims Of Wasteful Health Care Spending". KFF Health News.
  25. ^ Rau, Jordan (16 November 2009). "Reaction To Cooper's Challenge Against Dartmouth Atlas". KFF Health News.
  26. ^ Nanda, Anoop; Punjasthitkul, Sukdith; Skinner, Jonathan; Fisher, Elliott (2021). "Mapping COVID-19 by Hospital Referral Region (HRR)". Dartmouth Atlas dataverse. doi:10.21989/D9/ACQURP.
  27. ^ Shufro, Cathy (Fall 2021). "Mapping Out a New Dartmouth Atlas of Health Care" (PDF). Giving in Action.
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