Tag Archives: dartmouth atlas

Snapshot of state health spending yields some surprises

The Wall Street Journal and Louise Radnofsky did a nice package of interactive graphics and maps on state health spending. As Radnofsky noted, the high spenders are in the Northeast – but not only the Northeast. They are some rural states – but not all rural states. And Florida is up there.

It’s a fun and useful tool that gives you a snapshot of your state – and let you compare it with neighboring states or states with similar demographics.

But if you follow the work of the Dartmouth Atlas folks you’ll also know that spending doesn’t just vary by state – it varies by county, city – sometimes even neighborhood. Payment incentives is part – but only part – of the story. (They don’t explain why two hospitals in Manhattan may have such different utilization patterns, for instance). Local practice patterns, training, traditions, patient demographics all play a role.

Dartmouth Atlas report shows little improvement in readmissions

In the National Journal, Maggie Fox explains a new Dartmouth Atlas Project report (PDF) which demonstrates that, despite the looming implementation of penalties included in the Affordable Care Act and the existence of a simple, proven road map to improvement, most hospitals haven’t significantly cut down their readmission rates over the better part of the past decade.dartmouth-readmissions

“Only seven of the 94 academic medical centers we studied had statistically significant changes in 30-day readmission rates following medical discharge from 2004 to 2009,” [Dr. David Goodman’s] team wrote.

According to Goodman, improving readmission rates is a simple matter of actively scheduling follow-up visits and implementing a team approach to care delivery. Unfortunately, he told Fox, making that work in a busy hospital appears to be easier said than done, even with significant federal penalties lurking just over the horizon.

The 2010 health-care reform law begins using a stick in one year, penalizing hospitals with higher-than-expected readmission rates for Medicare patients treated for heart failure, heart attack or pneumonia. Medicare payments could be cut by up to 1 percent in October 2012, 2 percent in 2013 and 3 percent in 2014.

In addition to the overall message of the report, it’s interesting to note that readmission rates were affected by the same regional variation which has provided such fertile ground for reporters covering other Dartmouth Atlas Project research.

The percent of patients landing back in the emergency room within 30 days of discharge after surgery varied from less than 12 percent in 2009 in Rapid City, South Dakota, to 19 percent in Kingsport, Tennessee and 18 percent in Newport, Rhode Island.

For an example of how to localize the information in the report, see this article by Stacey Singer in The Palm Beach Post. To learn more about readmission data from CMS, see this article by Charles Ornstein, AHCJ president and ProPublica senior reporter.

UK’s Dartmouth-esque atlas yields familiar results

Writing for NPR’s health blog, Christopher Weaver looks at the NHS Atlas of Variation in Healthcare, which is similar to our Dartmouth Atlas. While they don’t have an interactive map up yet (they promise one will come next year), it has generous helpings of maps and graphs. The full PDF comes out to 100 pages and 19mb.

The most and least surprising thing about the NHS atlas? That, despite vastly different health care systems, it yields much the same results as the American version. I’ll let Weaver explain:

Before you blame … inconsistencies on America’s money-driven health system, take a look at Britain’s effort to anglicize the Dartmouth work: Doctors in some areas such as the college town of Oxford do one type of hip replacement at rates up to 16 times greater than in places like London, according to a November atlas by the National Health Service.

The British atlas is surprising because “doctors are not by and large paid on a fee for service basis in the NHS,” Angela Coulter, director of global initiatives for the Dartmouth Atlas-associated Foundation for Informed Medical Decision Making, said at a Salzburg Global Seminar session this week. “It illustrates the fact… that doctors tend to favor the treatments they’re trained to provide,” even when money isn’t a factor. Most British doctors get salaries rather than payments for each procedure like their American colleagues.


For more European health news, see AHCJ’s Covering Europe initiative.

Where you are determines your end-of-life care

As you’ve likely noticed, the Dartmouth Atlas team has now focused its lens on end-of-life care and found, not surprisingly, what amounts to “more of the same.” Kaiser Health News’ Jordan Rau has the nuts and bolts, while Joanne Kenen, writing for Miller-McCune Magazine,  takes a long view on the story, putting it into the context of popular Dartmouth Atlas pieces (think McAllen, Texas) and end-of-life outliers (La Crosse, Wis.). While you’ll have to check out her story for the in-depth version, here’s Kenen’s summary of the report:

Overall 1 in 3 of these patients died in the hospital, sometimes in the ICU and sometimes on life support, but there was significant variation from one region or even one hospital to another. Six percent of the patients received chemotherapy in the last two weeks of life, but in some regions and academic medical centers the rate went above 10 percent. Half got hospice but often for just a few days, too little for them and their families to fully benefit from the medical and psychosocial assistance and comfort hospice can offer.

If you’re looking for caveats, be sure to hit the second half of Rau’s story.

Reporters use county rankings for analysis

On Feb. 17, rankings of the relative health of counties in each American state were released by the Robert Wood Johnson Foundation and the University of Wisconsin. The rankings used data from 13 distinct (mostly federal) sources, including the National Center for Health Statistics, the Census Bureau and the Dartmouth Atlas. With that data, researchers computed eight separate composite scores, which were then weighted to produce one overall score. The ratings are navigated by clicking through a national map to the state and county level. Enough clicks will even bring you to the raw data itself. The state only compares counties, not states, because data collection varies from state to state and isn’t always standardized.

logo1It’s a combination of data, analysis and an intuitive interface, and journalists have been quick to localize the story. Many reporters reached beyond the easy numbers (“our county is 67th!”) to use the system for deeper stories.

For example, Robin Erb of the Detroit Free Press dissected the ratings process and how individual factors and disparities played into them before launching into the standard state breakdown.

Writing for Health News Florida, David Gulliver took a broader state view and considered how various socioeconomic factors played into the rankings of Florida counties. Gulliver’s analysis:

The strong-performing coastal counties, like Collier, St. John’s Sarasota, Charlotte, Palm Beach and Broward, all benefit from having heavy concentrations of retirees who have guaranteed health care access via Medicare. …

[Dr. Kevin Sherin, director of public health for Orange County] said that in Florida’s tourism and service industries, workers tend to be transient and less likely to have insurance or consistent primary care.

He noted the low-ranked counties were some of the poorest in Florida, like Union and Bradford in the rural north, and Glades and Okeechobee, with heavy populations of migrant workers. Those counties also tend to have more people who speak only Spanish, Creole or other languages.

Gulliver localized the story on a county level for his Sarasota Health News site.

In USA Today, Mary Brophy Marcus took the national view and looked for broad trends and generalizations. Marcus’ story was accompanied by a map by Frank Pompa highlighting each state’s healthiest and least healthy counties.