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  • 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.

  • 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.




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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.