Reporting of research data from the Dartmouth Atlas Project takes several forms. We have produced twenty book-length editions of The Dartmouth Atlas of Health Care; several brief reports covering specific topics and/or clinical subject areas; and a number of issue briefs on relevant health policy topics. Atlas investigators also have an extensive bibliography of scientific articles published in peer-reviewed journals. Please use the links on the right to locate our publications.
Recently released: After Hospitalization: A Dartmouth Atlas Report on Post-Acute Care for Medicare Beneficiaries, posted September 28, 2011, is the first national study looking at how effectively communities and hospitals coordinate care for patients leaving the hospital. The report reveals striking variations in 30-day readmission rates and little progress in reducing readmissions and improving care coordination between 2004 and 2009. Readmission rates for some conditions have increased for many regions and at many hospitals, including some of America's most elite academic medical centers. A significant proportion of Medicare patients did not see a clinician within 14 days of discharge. Rates of emergency room visits after discharge varied up to twofold across regions and academic medical centers.
A New Series of Medicare Expenditure Measures by Hospital Referral Region: 2003-2008, posted June 21, 2011, presents newly developed measures of Medicare spending based on a larger (20%) sample of claims and compares them to our previous spending measures. These new per capita spending rates are also adjusted for differences across regions in the prices paid by Medicare for similar services -- differences due both to higher costs in some regions, and to higher Medicare payments to hospitals with residency training programs and hospitals that serve a high percentage of low-income patients.
Trends and Variation in End-of-Life Care for Medicare Beneficiaries with Severe Chronic Illness, posted April 12, 2011, updates previous findings regarding variations in end-of-life care and documents trends from 2003 to 2007 in the use of medical resources to treat Medicare patients at the end of life, both among hospital referral regions and among 94 academic medical centers. Chronically ill Medicare patients were less likely to die in a hospital, spent fewer days in the hospital, and received more hospice care in 2007 than they did in 2003; but at the same time they had many more visits from physicians and spent more days in intensive care units.
Improving Patient Decision-Making in Health Care: A 2011 Dartmouth Atlas Report Highlighting Minnesota, posted February 24, 2011, examines the wide variations in elective surgery rates among 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. The report also describes the treatment choices available for several preference-sensitive conditions, all of which can—but do not have to be—treated with surgery, as well as steps patients can take to make sure they get the care they want and need.