Contents

• Tracking the Care of Patients with Severe Chronic Illness: The Dartmouth Atlas of Health Care 2008
• The Dartmouth Atlas Project
• Introduction
  • Health Care Spending, the Care of the Chronically Ill, and the Problem of Supply-Sensitive Care
  • Why do some regions spend more and do more?
  • When is more care worse?
  • Why we are interested in measuring care at the end of life
  • The contents of this Atlas
  • Endnotes
• Chapter One. Chronic Illness and the Problem of Supply-Sensitive Care
  • Is more care better?
  • How can more care be worse?
  • Understanding supply-sensitive care
  • Implications for patient preferences
  • Implications for evaluating efficiency in managing chronic illness
  • Endnotes
• Chapter Two. Variation Among States and Regions in Medicare Spending for Severe Chronic Illness
  • Variation in Medicare spending among states and regions
  • The relationship between spending, price, and volume
  • The relationship between sectors of care
  • Medicare inpatient spending
  • Medicare spending according to sector
  • Conclusions
• Chapter Three. How America’s Best Hospitals Manage Chronic Illness
  • Variation among America’s best hospitals
  • Volume or price: Which matters most?
  • How are resources used?
  • How intensely are patients treated?
  • Evaluating the relative efficiency of academic medical centers
  • Benchmarking excess spending due to overuse of hospitals and physician visits
  • Evaluating performance
  • Assumptions and facts concerning coordination between sectors of care
  • Assumptions and facts concerning “systemness”
  • Care intensity and patient choice
  • Conclusions
  • Endnotes
• Chapter Four. Evaluating the Management of Chronic Illness in Los Angeles
  • How Health Care Varies Among Los Angeles Hospitals
  • The relationship between volume and price among Los Angeles providers
  • Measuring the Performance of Los Angeles Hospitals
  • Spotlighting variation within Los Angeles neighborhoods
  • The Los Angeles predicament
  • Conclusions
  • Endnotes
• Chapter Five. Dealing with Unwarranted Variation
  • A strategy for improving the scientific basis of clinical care
  • A strategy for promoting the growth of organized care and reducing overuse
  • How hospitals might respond
  • How Catholic Healthcare West might respond
  • Hospital Corporation of America in Florida
  • How physicians might respond
  • Concerning feasibility
  • Endnotes
• Afterword
  • Accessing Information on the Dartmouth Atlas Website
  • Examples of routine reports
  • Endnotes
• Appendix on Methods
• Appendix Tables

Authors

John E. Wennberg, MD, MPH

Elliott S. Fisher, MD, MPH

David C. Goodman, MD, MS

Jonathan S. Skinner, PhD

Editor

Kristen K. Bronner, MA

Lead Analyst

Sandra M. Sharp, SM

The Dartmouth Atlas Working Group

Thomas A. Bubolz, PhD

Chiang-Hua Chang, MS

Vincent J. Fusca III, MMS

Daniel J. Gottlieb, MS

Jia Lan, MS

Zhao Peng, MS

Stephanie R. Raymond, BA

Dean T. Stanley

Jason Sutherland, PhD

Dongmei Wang, MS

Phyllis Wright-Slaughter, MHA

Library of Congress Cataloging-in-Publication Data

The Dartmouth Institute for Health Policy and Clinical Practice

Tracking the Care of Patients with Severe Chronic Illness/The Dartmouth

Institute for Health Policy and Clinical Practice

ISBN 978-0-9815862-0-5

Medical care – United States – Marketing – Maps. 2. Health facilities – United

States – Statistics. I. Title.

Copyright 2008 The Trustees of Dartmouth College