National Atlas Editions
Tracking the Care of Patients with Severe Chronic Illness: The Dartmouth Atlas of Health Care 2008
Our newest Atlas builds on the analyses presented in the 2006 edition. As before, the focus is on Medicare beneficiaries who had severe chronic illnesses and were in their last two years of life. This edition both updates the earlier analyses to encompass more recent data (through 2005) and expands the scope to include all sectors of care covered by the Medicare program. This Atlas also proposes new ways of thinking about how to achieve better care coordination and reduce the overuse of acute care hospital services. It offers concrete recommendations on the ways different stakeholders can use the new data - from choosing the right provider to reforming the U.S. health care system.
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The Care of Patients with Severe Chronic Illness: A Report on the Medicare Program
This edition of the Dartmouth Atlas reports on the last two years of life among Medicare enrollees with severe chronic illnesses. Several dimensions of care are examined: per decedent Medicare spending for hospital and physician care; FTE physician, hospital bed, and ICU bed inputs; physician visits; hospitalizations and stays in intensive care; and selected quality measures. The chapters document extensive variation in the amount, as well as the quality, of care given to chronically ill Medicare beneficiaries among states, regions, and from one hospital to another, even within the same region.
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The Quality of Medical Care in the United States: A Report on the Medicare Program
The Dartmouth Atlas of Health Care 1999
Variations in the intensity of use of hospitals, the striking differences in care at the end of life, and the nearly random patterns of elective surgery all raise questions about the outcomes and value of care -- about quality. Is more in fact better? What is the value received for the money spent? What is the cost of poor quality? Patients as well as health services researchers have begun to ask whether more really is better, and whether the "system" really is a system. Until we can answer those questions with any certainty, we will not be able to achieve real quality in American medical care. This edition uses data from 1995 & 1996.
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The Dartmouth Atlas of Health Care 1998
The Atlas shows once again that in health care, geography is destiny. The amount of care consumed by Americans is highly dependent on where they live - on the capacity of the health care system where they live, and on the practice styles of local physicians. Variations in the intensity of use of hospitals, the striking differences in the way terminal care is delivered, and the idiosyncratic patterns of elective surgery raise significant questions about the outcomes and value of health care. The fundamental questions posed by the Atlas are Which rate is right? How much is enough? and What is fair? This edition uses data from 1994 & 1995.
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The Dartmouth Atlas of Health Care 1996
The existence of large variations in the use of medical care among communities and regions raises a number of important issues. Foremost is the question "Which rate is right?" Another important issue raised by geographic variation concerns fairness. Variation studies provide good evidence that populations in low cost regions are not sicker or in greater medical need than those in high cost regions. A system that rewards high cost areas by continuing to pay their higher costs is by definition economically punishing areas that have fewer resources, use them more efficiently, and are reimbursed less. Is it fair for citizens living in regions with low per capita health care costs to subsidize the greater (and more costly) use of care by people living in high resource and high utilization regions? This edition uses data from 1992 & 1993.
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Surgical Variation Studies
Spine Surgery
This report focuses on trends and regional variations in spine surgery, particularly discectomy and laminectomy procedures and spine fusion. Two hospital referral regions with unusual patterns of utilization are also examined.

Cardiac Surgery
This study reports on national trends in coronary revascularization and valve replacement surgery from 1992 to 2003, and regional variations in procedure rates in 2003. Two hospital referral regions with unusual patterns of utilization - Redding, California for coronary bypass and valve replacement surgery, and Elyria, Ohio for coronary angioplasty - are also examined.

Trends and Regional Variations in Abdominal Aortic Aneurysm Repair
This report examines the impact of the introduction of endovascular AAA repair on utilization and outcomes. The data are drawn from Medicare discharge records from 1992 through 2003.
Specialty-Specific Editions
The Dartmouth Atlas of Cardiovascular Health Care
The first specialty-specific volume in the Dartmouth Atlas series deals with the most common chronic disease in the U.S. - ischemic heart disease- as well as cardiac conduction disease and valvular heart disease among the Medicare population. This edition uses data from 1996 & 1997.
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The Dartmouth Atlas of Vascular Health Care
Despite general progress in the field of vascular surgery, little is known about how vascular health care is currently being delivered in the United States. How often are patients undergoing surgery or other procedures in different parts of the country? Which types of specialists are providing vascular health care in different regions? How good are their outcomes? This Atlas helps focus attention on the most important questions and controversies in the field. This edition uses data from 1996 & 1997.
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The Dartmouth Atlas of Musculoskeletal Health Care
Musculoskeletal disease is a major cause of disability, and requires substantial health care expenditure in the United States. However, little is known about the demographics of musculoskeletal health care across our country. As we attempt to refine our treatment of musculoskeletal injury and disease, the variations in treatment patterns that are evident in the delivery of care are important to understand, particularly as this understanding can lead to an improvement in the care of musculoskeletal injuries and disease. This edition uses data from 1996 & 1997.
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State Editions
The Dartmouth Atlas of Health Care in Michigan
The Michigan atlas is the most extensive study of its kind of medical care in the state. Claims data from Blue Cross Blue Shield of Michigan, as well as Medicare data, was used to analyze the use and supply of health care services in Michigan. This edition uses data from 1996 & 1997.
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The Dartmouth Atlas of Health Care in Virginia
This Atlas uses the Virginia discharge data set as well as Medicare data to demonstrate again that the way health care resources are distributed and used at the local level depends more on the supply of resources and the practice style of local physicians than on differences in demographic or illness characteristics. This is as true for residents of Virginia as it is for people living elsewhere in the United States. This edition uses data from 1996 & 1997.

The Dartmouth Atlas of Health Care in Pennsylvania 1998
The first state-specific edition of Atlas uses the Pennsylvania discharge data set as well as Medicare data to show that the way health care resources are distributed and used at the local level challenges the conventional wisdom that illness determines the use of medical care, and the assumption that the supply of medical care arises in response to the demand for it. This edition uses data from 1994 & 1995.
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Regional Editions
Health care is highly local, and the analysis of patterns of resource distribution and utilization among hospital referral regions often masks important differences between the communities which, when aggregated, make up the larger region. Moreover, the task of actually addressing the problems of variation is often a local undertaking, one for which more specific - and more local - information is needed. The regional Atlas volumes focus on hospital service areas (HSAs) as the unit of analysis. The regional volumes make clear that there is often as much, and frequently more, variation among the hospital service areas within states and regions than among the larger units of analysis. These editions use data from 1992 & 1993.