Dartmouth Atlas: Powerful when used right

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

The Dartmouth Atlas contains detailed information on regional variations in health care spending and use and therefore has the potential to play a key role in the debate over health care cost and efficiency.

Nonetheless, it has come under fire in a few prominent publications lately. Writing for the Health Affairs blog, Amitabh Chandra defends the utility of the Atlas, pointing out that in many cases quibbles with the Atlas arise due to a lack of broad perspective or understanding of the health care system as a whole and an inability to properly interpret Dartmouth’s findings.

In addition to refuting certain attacks on the Atlas, Chandra expands his defense to include an outline of just why it can be a useful resource when trying to evaluate health care spending and effectiveness.

To learn more about the Dartmouth Atlas and how to use it to determine how medical resources are distributed and used in the United States, read AHCJ’s Covering Hospitals, a slim guide that focuses on how journalists can best use Dartmouth Atlas and Hospital Compare.

1 thought on “Dartmouth Atlas: Powerful when used right

  1. Lori Nerbonne

    I hope that the journalists at AHCJ will ask the researchers at The Dartmouth Atlas Project why they don’t tease out the data on how quality of care affects over-use and high costs in the last 2 years of life.

    They Atlas research data shows that there are numerous specialists, tests, hospital days, etc, etc, in those last two years. But, if just one preventable complication happens to an otherwise healthy Medicare patient after surgery….that can lead to months of hospitalization and ‘over-use’. The problem is that the overuse could have been prevented by better quality/preventing the complication that led to the over-use.

    I asked Eliot Fisher if they do tease out this data to see how much of an impact poor quality/preventable errors or complications have on over-use and he said they don’t look at that.

    This has significant implications. The devil is in the details here. I’m sure my mother’s case happens a lot; what was supposed to be a 5 day stay recovering from surgery—-turned into 8 months of severe “over-use” (sepsis from MRSA, a bedsore, at least 2o more infections, 2 broken ribs, etc.) and over 1 million dollars in costs. If they are not digging into these details, and instead making a global statement that it’s technology-driven overuse instead of preventable complications that lead to the overuse in many cases, then this will lead us to incomplete solutions.

    Healthgrades data shows that sepsis, failure to rescue and respiratory failure are the leading patient safety incidents causing death to Medicare patients. This is exactly what happened in my mother’s case.

    So why aren’t the Dartmouth Atlas Researchers looking at this data to expose the issue of how poor quality drives up the costs and over-utilization in the last 2 years of life.

    And probably the most important revelation to this is that it wouldn’t have been the last 2 years of her life if that initial post-operative infection hadn’t happened.
    She’d still be alive today.

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