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  • December 3, 2014: Regional Rates of Prostate Cancer Screening Vary by a Factor of Fifteen.

    The likelihood that an older man will undergo controversial screening for prostate cancer largely depends on where he lives, with men in some regions in the U.S. 15 times more likely to get prostate specific antigen (PSA) screening tests than in others, according to a new report from the Dartmouth Atlas Project. The report, which reflects 2010 data, offers additional evidence of the confused state of prostate cancer screening in advance of the United States Preventative Services Task Force's (USPSTF) 2012 recommendation against PSA screening for adult men of all ages.

  • November 12, 2014: Surgical Treatment for End-Stage Renal Disease Could Save Medicare Billions.

    Medicare beneficiaries suffering from kidney failure typically get the most costly and least effective treatment, hemodialysis using an intravascular catheter, according to a report from the Dartmouth Atlas Project. Hemodialysis for patients with end-stage renal disease (ESRD), or kidney failure, accounted for 6.2 percent ($34.3 billion) of the total Medicare budget in 2010. Hemodialysis treatment costs Medicare 2.6 times more per person per year than kidney transplants and also is less effective. What’s more, according to the report, an individual’s likelihood of survival varies greatly across the country, based on access to specialists and transplant centers.

  • October 29, 2014: Treatment of Spinal Stenosis Shows Vast Regional Variance.

    Surgical treatment for patients with low back pain resulting from spinal stenosis varies dramatically across the United States and whether an individual undergoes lumbar decompression or increasingly popular, but controversial, spinal fusion to alleviate the pain differs widely across regions, according to a report from the Dartmouth Atlas Project, Variation in the Care of Surgical Conditions: Spinal Stenosis.

  • October 14, 2014: Significant Racial Disparities Identified in Diabetes Related Amputations.

    There are significant racial and regional disparities in the care of patients with diabetes, according to a report from the Dartmouth Atlas Project released October 14, 2014, Variation in the Care of Surgical Conditions: Diabetes and Peripheral Arterial Disease. The report found that black patients are less likely to get routine preventive care than other patients and three times more likely to lose a leg to amputation, a devastating complication of diabetes and circulatory problems. Amputation rates vary fivefold across U.S. regions and are particularly high in the rural Southeast.

  • September 30, 2014: Striking Regional Variation in the Treatment of Cerebral Aneurysms.

    Surgical treatment for cerebral aneurysms varies widely across the country, and the treatment decision is likely driven by local practice patterns and not by patient preference, according to a report from the Dartmouth Atlas Project. The report, Variation in the Care of Surgical Conditions: Cerebral Aneurysms, is the second in a series of six reports from the Dartmouth Atlas of Health Care examining unwarranted variations in the surgical care of Medicare beneficiaries. Like a previous report on surgical treatment for obesity, it calls for greater patient involvement in decision making when options exist and circumstances permit.

  • September 16, 2014: Bariatric Surgery Rates All Over the Map.

    Medicare beneficiaries are 27 times more likely to undergo bariatric surgery in Muskegon, Michigan than in San Francisco, according to a report from the Dartmouth Atlas Project examining unwarranted variations in surgical treatment for obesity. Research from a new series of reports, called Variation in the Care of Surgical Conditions, found that a region’s rate of bariatric surgery “had virtually no relationship” with its population’s rates of diabetes and obesity. The report also found that while the preferences of the region’s health care providers, a reflection of their training and experiences, are a major contributor to variations, patient preferences are not.

  • December 11, 2013: Where Children Live Affects Their Health Care, Exposing Some to Unnecessary Treatment, Imaging, and Medication.

    Whether children are receiving recommended care or are subjected to potentially unneeded treatments varies widely depending on where they live, according to the Dartmouth Atlas Project’s first report on health care provided to children and infants, "The Dartmouth Atlas of Children's Health Care in Northern New England", released December 11, 2013, which examines care in Maine, New Hampshire, and Vermont. Overall, the study finds that in regions with fewer ambulatory office visits, children were more likely to end up in the emergency room and less likely to receive recommended care. Dartmouth researchers also find that many children in Northern New England are receiving potentially unneeded care that exposes them to harmful side effects and burdens their families with unnecessary medical bills.

  • October 15, 2013: Prescription Drug Use among Medicare Patients Highly Inconsistent.

    In its first look at prescription drug use, "The Dartmouth Atlas of Medicare Prescription Drug Use", released October 15, 2013, the Dartmouth Atlas Project shows that the use of both effective and risky drug therapies by Medicare patients varies widely across U.S. regions, offering further evidence that location is a key determinant in the quality and cost of the medical care that patients receive. The report also finds that the health status of a region’s Medicare population accounts for less than a third of the variation in total prescription drug use, and that higher spending is not related to higher use of proven drug therapies. The study raises questions about whether regional practice culture explains differences in the quality and quantity of prescription drug use.

  • September 4, 2013: One in Four Medicare Patients with Advanced Cancer Dies in the Hospital, While Care Intensity at the End of Life Increases.

    "Trends in Cancer Care Near the End of Life," a brief from the Dartmouth Atlas Project finds that although the use of hospice care for Medicare patients with advanced cancer is increasing, many patients do not receive hospice care until they are literally on their deathbed, within three days of the end of life. Paradoxically, the updated data also find that in 2010, despite increases in the use of hospice care, more patients were also treated in intensive care units (ICUs) in their last month of life than in the period from 2003 to 2007. Care for elderly patients with cancer continues to not necessarily reflect the patients’ preferences, but the styles of treatment in the regions or health care systems where they happen to receive cancer treatment. The report concludes that where patients with advanced cancer live continues to play an important role in the care they receive.

  • June 12, 2013: Medicare Spending and Care Intensity at the End of Life Increases, While Time in the Hospital Declines.

    Medicare spending for chronically ill patients at the end of life increased more than 15 percent from 2007 to 2010, according to a new brief from the Dartmouth Atlas Project. The updated data also shows that Medicare patients spent fewer days in the hospital and received more hospice care in 2010 than they did in 2007.

  • February 21, 2013: Hospitals Reimbursements Based on Illness of Patients Are Susceptible to Bias Due to Intensity of Care.

    Common methods designed to enable apples-to-apples comparisons of the performance of doctors and hospitals and fairly credit providers for treating patients who are sicker than average may themselves be biased, because they make some patient populations appear to be sicker than others when they are not, according to a study by Dartmouth researchers. In a series of papers, the latest of which was published February 21, 2013 in the British Medical Journal, a research team led by the Dartmouth Atlas Project and The Dartmouth Institute for Health Policy & Clinical Practice raises significant questions about the “risk adjustment” that Medicare and others apply to insurance claims data in an effort to make fair comparisons about performance, spending, resource use, and mortality rates among regions and hospitals.

  • February 11, 2013: The Revolving Door Syndrome: Patients Returning to Hospital Within Days of Being Released.

    The Robert Wood Johnson Foundation (RWJF) released a report on February 11, 2013 showing that one in eight Medicare patients were readmitted to the hospital within 30 days of being released after surgery in 2010, while patients in the hospital for reasons other than surgery returned at an even higher rate of one in six. Both rates were virtually unchanged from 2008. The findings are based on new data that includes readmission rates for states, hospital referral regions, and more than 3,000 hospitals from the Dartmouth Atlas Project, largely funded by RWJF. The report, “The Revolving Door: A Report on U.S. Hospital Readmissions,” also includes the results of a novel series of in-depth interviews with patients and providers that shed light on why so many patients end up back in the hospital and what hospitals, doctors, nurses, and others are doing to limit avoidable readmissions.

  • November 29, 2012: Elective Surgery in the United States: Location Matters.

    Medicine involves decisions. But for Medicare patients with conditions for which surgery is an option, whether they undergo elective surgery depends largely on where they live and the clinicians they see, according to research from the Dartmouth Atlas Project. The research suggests that for many conditions -- especially those that can be treated with elective surgery -- the treatment a patient receives depends more on the physician's recommendations than the patient's preferences. When studying elective procedures across the nation, researchers found remarkable variation in these surgeries for Medicare patients, even though they had similar conditions. Nine editions highlight different regions around the country and shows the variation that exists even within these smaller areas. Click here for the series.

  • October 30, 2012: For Physician Residents, Where You're Taught Medicine Influences How You Practice.

    When choosing a residency program, medical students typically consider the reputation and training curriculum of the institution, as well as their own geographical and lifestyle preferences. But there's something else they should consider: The way academic medical centers deliver health care differs dramatically from one institution to the next. "What Kind of Physician Will You Be? Variation in Health Care and Its Importance for Residency Training," a report from the Dartmouth Atlas Project led by physicians in training, found that 23 top academic medical centers vary markedly in the intensity of care they provide patients at the end of life, in their quality, safety and patient experience ratings, and in their use of surgical procedures when other treatment alternatives exist.

  • September 11, 2012: Significant Potential for Accountable Care Organizations to Improve Care, Lower Costs-Especially for Sickest Patients.

    New health care delivery models that reward providers for coordinating and improving care hold promise for slowing the cost of treating the sickest, costliest patients in the health care system, according to "Spending Differences Associated With the Medicare Physician Group Practice Demonstration," a study by Dartmouth researchers published in the Sept. 12 issue of the Journal of the American Medical Association.

  • April 9, 2012: Care for Dying Medicare Patients at Elite Cancer Centers Differs Little from Community Hospitals.

    The nation's most elite cancer care centers performed only modestly better than community hospitals at meeting recognized quality standards for treating dying cancer patients, according to a study by Dartmouth researchers published in the April 2012 issue of Health Affairs. The Dartmouth researchers also found that even among hospitals with a specific clinical focus on cancer care, there were significant variations in how they treated patients at the end of life.

  • January 27, 2012: Moving Beyond Medicare: Dartmouth Atlas Researchers to Analyze Variations in Pediatric Care, Under-65 Population.

    The Dartmouth Atlas Project is once again branching out beyond Medicare. Dartmouth researchers have announced plans to develop their first regional study on variations in pediatric health care, funded by a two-year grant from the New England-based Charles H. Hood Foundation, and collaboration with Blue Health Intelligence® to study geographic variation in a commercially insured adult population.

  • September 28, 2011: U.S. Hospitals, Facing New Medicare Penalties, Show Wide Room for Improvement at Reducing Readmission Rates.

    As new Medicare penalties kick in for hospitals with excessive numbers of patients returning to the hospital shortly after they are discharged, a new report, "After Hospitalization: A Dartmouth Atlas Report on Post-Acute Care for Medicare Beneficiaries," published September 28, 2011, shows little progress over a five-year period in reducing readmissions and improving care coordination for Medicare patients. On the contrary, readmission rates for some conditions have increased for many regions and at many hospitals, including some of America's most elite academic medical centers. The study also found that facilities and regions with general patterns of high use of hospitals for medical conditions were frequently the same places with high readmission rates, an indication that some communities are more likely than others to rely on the hospital as a site of care across the board.

  • May 25, 2011: More Primary Care Associated with Positive Health Outcomes for Medicare Patients.

    Medicare patients living in areas with higher levels of practicing primary care physicians have lower death rates and make fewer trips to the hospital for preventable conditions, according to "Primary Care Physician Workforce and Medicare Beneficiaries' Health Outcomes," a study by Dartmouth investigators published May 25, 2011 in the Journal of the American Medical Association. The study’s findings suggest that a larger local workforce of primary care physicians has a positive benefit for Medicare patients, but this association may not simply be the result of having more physicians in an area who are trained in primary care; instead, the benefits may be more from the amount of ambulatory clinical care provided, rather than the number of primary care physicians locally available.

  • April 12, 2011: U.S. End-of-Life Care Changing: While Medicare Patients Are Spending Less Time in the Hospital, Those Admitted Receive More Intensive Care.

    Chronically ill Medicare patients spent fewer days in the hospital and received more hospice care in 2007 than they did in 2003, but at the same time there was an increase in the intensity of care for patients who were hospitalized, according to the Dartmouth Atlas Project report “Trends and Variation in End-of-Life Care for Medicare Beneficiaries with Severe Chronic Illness.” While Medicare patients diagnosed with severe chronic illness were less likely to die in a hospital and more likely to receive hospice care, at the same time, they had many more visits from physicians and spent more days in intensive care units. Growth in intensive care and medical specialist capacity, the researchers say, can lead to increased aggressiveness of care.




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The Dartmouth Atlas of Health Care is based at The Dartmouth Institute for Health Policy and Clinical Practice and is supported by a coalition of funders led by the Robert Wood Johnson Foundation, including the WellPoint Foundation, the United Health Foundation, the California HealthCare Foundation, and the Charles H. Hood Foundation.