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: Variation in the Care of Surgical Conditions. This volume combines the six surgery reports described below into one anthology. Each chapter begins with an examination of the underlying condition, the available treatment options before surgery, and the role of shared decision-making. The care during surgery is then presented, including aspects of quality, risks, and costs. The next section is concerned with the care of patients after surgery, including hospital readmissions and ambulatory care.
Variation in the Care of Surgical Conditions: Prostate Cancer. Despite many years of attention and study, variation in the diagnosis and treatment of prostate cancer persists in the United States. While some progress has been made, new questions have arisen: for example, how best to counsel patients regarding their risk of cancer and the benefits and trade-offs of treatment; how to optimize outcomes related to treatment; and which patients are best treated with active surveillance. While these questions are being answered, clinicians and health systems need to continue to work to incorporate the best available evidence and shared decision-making into their efforts to detect and treat prostate cancer.
Variation in the Care of Surgical Conditions: End-Stage Renal Disease. This report highlights treatments for kidney failure--both dialysis and kidney transplantation--and describes patterns of care for patients in the United States. The evolution of ESRD treatments is first presented, from basic surgical techniques and rudimentary dialysis machines to the complex, multi-specialty model practiced today. Most importantly, the report examines current quality improvement initiatives and identifies areas in need of system-level improvement.
Variation in the Care of Surgical Conditions: Spinal Stenosis. Back pain is a leading cause of morbidity and disability in the United States. About 30 million people in the United States receive professional medical care for a spine problem each year. Low back pain is a leading cause of both lost productivity and medical expenditures. This report focuses on lumbar spinal stenosis as an example that helps to summarize the treatment options, epidemiology, and evidence of effectiveness of treatment for back pain.
Variation in the Care of Surgical Conditions: Diabetes and Peripheral Arterial Disease. This report examines how Medicare patients with diabetes and PAD are treated across the United States. It describes how, when, and why they may (or may not) be treated with preventive measures, as well as invasive treatments aimed at limiting amputation. By examining these treatment patterns, and outlining the ways in which physicians have attempted to study and improve the care of these complex patients, we hope to highlight opportunities to reduce amputations for patients at the highest risk for limb loss.
Variation in the Care of Surgical Conditions: Cerebral Aneurysms. This report focuses on the common and potentially dangerous medical condition of cerebral aneurysms. There is considerable regional variation in the United States in the treatment of ruptured and unruptured cerebral aneurysms, suggesting that patients do not always receive the most optimal treatment, which has implications for both quality and cost. The report concludes that patients who receive a new diagnosis of cerebral aneurysm (especially unruptured) face a difficult road to informed decision-making.
Variation in the Care of Surgical Conditions: Obesity. This report discusses the growing problem of obesity in the U.S. population and shows different approaches to its treatment over time and by region. It focuses on the surgical treatment of obesity, including the decision to use surgery, the technical quality of surgical care, and patient outcomes. The trends and regional variation presented in this report reflect a combination of factors: the rise of obesity rates; the development of new therapies, particularly less invasive and more effective surgical techniques; and evolving policies related to safety and insurance coverage. Most importantly, regional variation raises questions about a lack of consensus within the medical community regarding the use of bariatric surgery and the role of patients in making fully informed decisions about their care. And finally, while progress has been made in understanding the best ways to limit obesity using surgical and medical approaches, areas in need of further improvement are highlighted.