Recent News & Press Releases
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.
March 17, 2011:
Geography's Influence on Chronic Disease Diagnosis.
The likelihood of Medicare patients being diagnosed with one or more of nine chronic diseases may depend on where they live and the doctors they see, in addition to how healthy or sick they actually are, according to "Geographic Variation in Diagnosis Frequency and Risk of Death Among Medicare Beneficiaries," a new study by Dartmouth investigators published in the Journal of the American Medical Association. This geographic variation raises important questions about the methods used to adjust risk for the severity of illness in comparative effectiveness research, the evaluation of hospital readmissions, and paying insurance plans under the Medicare Advantage program and elsewhere, including academic research into the extent of variations in medical care across America.
February 24, 2011:
When It Comes to Elective Surgery, Location Matters.
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 a report from the Dartmouth Atlas Project and the Foundation for Informed Medical Decision Making released February 24, 2011. The study, "Improving Patient Decision-Making in Health Care: A 2011 Dartmouth Atlas Report Highlighting Minnesota," shows remarkably wide regional variations in elective surgery for Medicare patients with similar conditions. In addition to analyzing data on practice patterns, the report also advocates for shared decision-making, a process that helps patients understand their choices fully and allows them to share treatment decisions with their clinicians.
February 3, 2011:
More Physician Supply Doesn’t Lead to Higher Patient Satisfaction.
Medicare patients living in areas with a higher supply of physicians were no more satisfied with their care than patients living in regions with a lower physician supply, according to a study released February 3, 2011 by Dartmouth investigators and the Centers for Medicare and Medicaid Services. The study, "Seniors’ Perceptions Of Health Care Not Closely Associated With Physician Supply," also found that seniors living in areas with a high supply of physicians were no more likely to report having a primary care physician as their personal doctor. In addition, there were no significant differences in the amount of time spent with a physician, or access to tests or specialists.
November 16, 2010:
Nearly One Third of Medicare Patients with Advanced Cancer Die in Hospitals and ICUs: About Half Get Hospice Care.
Whether Medicare patients with advanced cancer will die while receiving hospice care or in the hospital varies markedly depending on where they live and receive care, according to the Dartmouth Atlas Project’s first-ever report on cancer care at the end of life, "Quality of End-of-Life Cancer Care for Medicare Beneficiaries." The researchers found no consistent pattern of care or evidence that treatment patterns follow patient preferences, even among the nation’s leading academic medical centers. Rather, with one in three Medicare cancer patients spending their last days in hospitals and intensive care units, the report’s findings demonstrate that many clinical teams aggressively treat patients with curative attempts they may not want, at the expense of improving the quality of their life in their last weeks and months.
September 9, 2010:
Dartmouth Atlas Project Finds Access and Use of Primary Care Does Not Guarantee Better Health Outcomes.
Meeting the nation's primary care needs is more than a numbers game. "Regional and Racial Variation in Primary Care and the Quality of Care Among Medicare Beneficiaries," a report from the Dartmouth Atlas Project, shows that neither delivering a greater amount of primary care, nor making sure patients routinely see a primary care clinician is, by itself, a guarantee that a patient will get recommended care or experience better outcomes. Researchers also found that patients' access to and use of primary care, the quality of overall care, and their likelihood of hospitalization varied markedly in different locations. The report shows that improving access to primary care alone does not always keep people with chronic conditions out of the hospital, improve their chances of getting the optimal care recommended for their condition, or improve health outcomes.
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.