April 16, 2008: Claims of Physician Workforce Crisis Ignore Real Problems in Health Care. Increasing the size of the physician workforce has not led overall to better care, greater availability of care, or patient satisfaction with medical care. By simply adding physicians, we would be treating the symptoms of an ailing health care system, while ignoring the underlying disease: "a largely disorganized and fragmented delivery system, characterized by lack of coordination, incomplete patient information, poor communication, uneven quality, and rising costs." Moreover, increasing the size of the workforce is likely to worsen existing problems and potentially create more. Press release

April 7, 2008: Chronically Ill Patients Get More Care, Less Quality, Says Latest Dartmouth Atlas. Medicare pays many hospitals and their doctors more than the most efficient and effective health care institutions to treat chronically ill people, yet gets worse results, according to a new report from the Dartmouth Institute for Health Policy and Clinical Practice. Tracking the Care of Patients with Severe Chronic Illness shows that institutions that give better care can do it at a lower cost because they don't over-treat patients. However, the Atlas documents that Medicare and most other payers encourage the over-use of acute care hospital services and the proliferation of medical specialists thanks to misplaced financial incentives, especially for treating chronically ill people. Caring for people with chronic disease now accounts for more than 75% of all health care spending. And over-use and overspending is not just a Medicare problem - the health care system as a whole lacks efficient, effective ways of caring for people with severe chronic illnesses. Read the press release, Executive Summary, or the full report.

February 20, 2008: Surgery is Best for Patients with Spinal Stenosis, Third SPORT Study Shows. Individuals suffering from a common back condition known as spinal stenosis improve more with surgery than with non-surgical treatment, according to a multi-center, multistate trial led by Dartmouth clinician-researchers. However, the study also reveals that patients who choose not to have surgery are likely to improve over time. Press release

July 24, 2007: Dartmouth College, Brookings Institution Announce Partnership: Mark McClellan and Elliott Fisher to Head Joint Health Policy Initiative. A program to improve the value of health care by addressing uneven quality and excess costs was unveiled recently by the Brookings Institution and Dartmouth College. The initiative will link population-based research programs at the newly-created Dartmouth Institute for Health Policy and Clinical Practice with the health policy research and development expertise of scholars at the Brookings Institution. The Brookings-Dartmouth initiative will focus on bringing researchers, lawmakers, and regulators together to develop and implement policies to address major failings in the U.S. health care system. Press release

Spring 2007: "The U.S. spends more on health care than any other nation. Does that money buy what it should? Not according to decades of Dartmouth research on regional variations in spending and outcomes. But policy-makers are now paying attention to the DMS work - and therein may lie a solution to the money-medicine puzzle." This passage introduced the cover article by Maggie Mahar in Dartmouth Medicine's Spring 2007 issue, entitled "The State of the Nation's Health." The article featured the work of the Dartmouth Atlas project and the Center for the Evaluative Clinical Sciences (now The Dartmouth Institute for Health Policy and Clinical Practice). Read the article, view interviews with Dr. Wennberg, or read transcripts of interviews.

December 5, 2006: America's Health Rankings: The United Health Foundation released the 2006 edition of America's Health Rankings: A Call to Action for People and Their Communities. This year's ranking included state-level findings from the Dartmouth Atlas Project. The report showed not only tremendous variation in the quality and cost of medical care among the states, but that providing more services did not lead to better-quality care. In fact, in some states, the greater use of services was associated with poorer quality and lower satisfaction with care.

December 5, 2006: Establishing accountability for quality and costs: Organized care beats disorganized care. The question is how to organize it. Most physicians do not practice medicine in the multi-specialty group practices, or in similar practices integrated with hospitals, that have been shown to be the most effective and efficient delivery systems for care. In a recent Health Affairs article, Dr. Elliott Fisher and coauthors advocate focusing accountability for quality and cost on the "extended hospital medical staff." The paper demonstrates that all physicians are already members of a virtual multi-specialty medical group -- the physicians who work in or whose patients are admitted to a local hospital -- and patients, especially those who have chronic diseases, receive the vast majority of their care from these local delivery systems. It is therefore feasible to develop performance measures for these organizations. Dr. Fisher also presented his findings to the Medicare Payment Advisory Commission (MedPAC) November 9, 2006. A transcript of his testimony is available here.

October 2006: Dartmouth Atlas research was featured prominently in a five-day USA Today/ABC News collaboration on the U.S. health care system. USA Today reported on findings published in the November 2006 issue of Spine revealing the steady increase in rates and Medicare spending for spine surgery, particularly lumbar fusion. Another article in USA Today used Dartmouth Atlas data to explore variation in end-of-life costs. ABC News featured the Intermountain Health Care system in Salt Lake City, which the Atlas used as a benchmark for efficiency in the treatment of the chronically ill. Finally, the ABC/USA Today collaborative named the Dartmouth Atlas of Health Care web site as one of the five most important web sites in health policy.

Spring 2006: There is no need to expand physician workforce training to meet the future needs of an aging population; the current supply, if employed efficiently, is adequate through 2020. "Spending millions of dollars annually to expand our capacity to train physicians will create an oversupply at the same time that it diverts health care dollars from care that has been shown to improve the health and well being of patients," according to David C. Goodman, M.D., and colleagues at Dartmouth's Center for the Evaluative Clinical Sciences (now TDI). The research was published by the journal Health Affairs in its March/April 2006 issue.

Instead of expanding the number of physicians being trained, efforts should be aimed at increasing the efficiency of medical practice and directing resources to care that has been proven to be effective. In some parts of the country, people with severe chronic illnesses receive more physician care in visits, hospitalizations, and procedures than people who live in areas with fewer physicians per capita, but do not realize a benefit, and might actually be harmed by unnecessary medical care. Large interdisciplinary (or multi-specialty) group practices provide a model of both excellence and efficiency in the management of patients with chronic illnesses.  Interview with Dr. Goodman

November 16, 2005: Medicare pays some California hospitals four times more than others, without improving outcomes or patient satisfaction. Despite the wide differences in spending among hospitals in California, there is no gain in quality or patient satisfaction, according to a study by the Center for the Evaluative Clinical Sciences at Dartmouth Medical School (now TDI). The ground-breaking study, released by the California HealthCare Foundation, looked at the performance of individual California hospitals in managing seriously ill patients over a five-year period. The study found that eliminating "Medicare overcare" by improving hospital efficiency could have saved Medicare $1.7 billion over five years in Los Angeles alone.

The data used in this study, available to the public for the first time, enables direct comparisons of the efficiency of individual hospitals in treating patients with chronic illness based on the Medicare claims from hospitals and their associated physicians. The results make it possible to compare and rate market areas as well as individual hospitals on the efficiency with which they use health care resources.

The findings are available in a web-exclusive edition of the journal Health Affairs. Concurrently with the release of the Health Affairs article, the Dartmouth Atlas of Health Care Project released performance measures for California hospitals and hospital referral regions. Press kit and information

November 16, 2005: Topic Briefs: Underuse of Effective Care, Overuse of Supply-Sensitive Care, and Misuse of Preference-Sensitive Care. The Dartmouth Atlas Project has documented three sources of unwarranted variation in the practice of medicine and the use of medical resources across the United States. These new briefing papers are beginner's guides to these categories. The underuse of effective care includes such problems as the failure to give beta-blockers consistently to people who have had heart attacks, or to routinely screen diabetics for early signs of retinal disease. Even hospitals considered among the "best" in the country - including some academic medical centers - fail to take these proven steps. Misuse of preference-sensitive care refers to situations in which there are significant tradeoffs among the available options, yet often the patient's values and preferences are not taken into account when deciding the course of treatment. The overuse of supply-sensitive care is particularly apparent in the management of chronic illness, where there is often an over-dependence on hospitals and a lack of the infrastructure necessary to support the management of chronically ill patients in non-inpatient settings. In the absence of medical evidence regarding such questions as when to schedule return visits, when to hospitalize or admit to intensive care, when to refer to a medical specialist, and, for most conditions, when to order a diagnostic or imaging test, the availability of resources tends to govern these decisions.

October 2004: Dartmouth studies show wide variations in hospital care and outcomes for chronically ill Medicare patients. Medicare patients with similar chronic conditions receive strikingly different care, even among hospitals identified as "best" for geriatric care by U.S. News & World Report, according to one of several Dartmouth Medical School studies featured in a special issue of Health Affairs.