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• June 23, 2010: Responses to the New York Times.

  The Dartmouth Atlas responded twice to "Critics Question Study Cited in Health Debate" and subsequent follow-ups by Reed Abelson and Gardiner Harris of The New York Times. The first response was June 3 and the second was June 23.

• May 12, 2010: Considering Moving? Where You Go Determines Whether You Will Be Told You're Sick.

  Medicare beneficiaries who move to some regions of the United States receive many more diagnostic tests and new diagnoses than those who move to other regions, according to a study by Dartmouth investigators in the New England Journal of Medicine. The paper raises important questions about whether being given more diagnoses is beneficial to patients and may help to explain recent controversies about regional differences in spending.

• April 15, 2010: Dartmouth Atlas Project Finds Substantial Variation in Joint Replacement Surgery.

  The rates of hip, knee, and shoulder replacement for Medicare patients are growing rapidly, and there is widespread variation in how likely patients are to undergo surgery depending on where they live and their race, according to a report released by the Dartmouth Atlas Project. "Trends and Regional Variation in Hip, Knee, and Shoulder Replacement" finds substantial increases in overall rates of joint replacement from 2000-2001 to 2005-2006. Meanwhile, the rate of shoulder replacement was 10 times higher in some regions than others during 2005-2006, and the rates of hip and knee replacements were four times higher.

• April 2, 2009: U.S. Hospital Bed Supply Shrinks While Hospital Workforce Grows.

  The supply of hospital beds and doctors varies widely from region to region across the United States, and the variations have nothing to do with the level of care patients want or need, according to a new report from the Dartmouth Atlas Project. "Hospital and Physician Capacity Update," released April 2, 2009, analyzes current hospital and physician capacity as well as trends over a 10-year period, and reveals irrational distribution of these valuable and expensive health care resources. The report finds similar wide and persistent variations in capacity in 2006 to those that existed in 1996, generally in the same places.

• March 12, 2009: Linking Workforce Policy to Health Care Reform.

  Dr. David Goodman gave invited testimony at the United States Senate Committee on Finance Hearing on "Workforce Issues in Health Care Reform: Assessing the Present and Preparing for the Future." Dr. Goodman advanced the idea of a permanent health workforce commission to craft evidence-based policy that improves access to care, health outcomes and the quality and affordability of care.

• February 26, 2009: Taming Wide Variations in Spending Key to Health Reform.

  Huge inefficiencies in the U.S. health care system are hamstringing the nation's ability to expand access to care, according to a new analysis of Medicare spending by researchers of the Dartmouth Atlas Project, published February 25, 2009 in the New England Journal of Medicine. Many experts have blamed the growth in spending on advances in medical technology. But the differences in growth rates across regions show that advancing technology is only part of the explanation. Patients in high-cost regions have access to the same technology as those in low-cost regions, and those in low-cost regions are not deprived of needed care. On the contrary, the researchers note that care is often better in low-cost areas. The authors argue that the differences in growth are largely due to discretionary decisions by physicians that are influenced by the local availability of hospital beds, imaging centers and other resources-and a payment system that rewards growth and higher utilization.

• January 27, 2009: Shared Savings: Payment Reform that Promotes High-Quality Care and Reduces Medicare Spending Growth.

  Medicare could save money and improve health care quality by providing financial incentives to providers for coordinating patient care through a shared savings program, according to a new paper from the Dartmouth Institute for Health Policy and Clinical Practice and the Engelberg Center for Health Care Reform at the Brookings Institution. Research by Elliott Fisher, Mark McClellan, and colleagues demonstrates that such a program, implemented with the establishment of Accountable Care Organizations (ACOs), would benefit patients, payers, and providers. The ACO shared savings concept would eliminate waste, reduce overuse and misuse of care, and support the development of health systems that can deliver high quality, affordable care.

• December 17, 2008: Expanding Coverage without Increasing Health Care Spending: Dartmouth Institute White Paper Recommends Course for the Obama Administration.

  A new Dartmouth Atlas white paper makes the case that the United States can extend coverage to the country's uninsured without substantially increasing overall health care costs. The paper argues that the incoming Obama Administration and the Congress can adopt measures that will improve health care quality and patient outcomes, while reducing the growth of health care spending. Download "An Agenda for Change: Improving Quality and Curbing Health Care Spending: Opportunities for the Congress and the Obama Administration."

• October 13, 2008: Dartmouth’s John E. Wennberg Wins Prestigious Lienhard Award.

  Dr. John E. Wennberg today received the 2008 Gustav O. Lienhard Award from the Institute of Medicine for "reshaping the U.S. health care system" to focus on objective evidence and outcomes rather than physician preference as the basis for treatment decisions, and for his efforts to empower patients with greater input on decisions about their own care.

• September 17, 2008: It Takes a Neighborhood: Creating the Structure for the Medical Home.

  The medical home has great potential to improve the delivery of coordinated health care to patients. But significant obstacles still exist in making the transition from model to reality, writes Dr. Elliott S. Fisher in the September 18th issue of the New England Journal of Medicine. A lack of incentives for providers to share information, unclear evidence that patients and physicians will embrace the medical home concept, and questions about whether the medical home will actually result in reduced health care spending, are barriers that must be addressed.

• 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.

• 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.

• 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.

• July 24, 2007: Dartmouth College, Brookings Institution Announce Partnership.

  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.

• April 1, 2007: The State of the Nation's Health.

  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).

• 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.

• December 5, 2006: America's Health Rankings: A Call to Action for People and Their Communities.

  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.

• October 17, 2006: Dartmouth Atlas Research in the News.

  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.

• March 1, 2006: There is no need to expand physician workforce training to meet the future needs of an aging population.

  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.

• November 16, 2005: From Sacramento to Los Angeles, More Health Care is Not Necessarily Better Health Care.

  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.