Contents

• The Dartmouth Atlas of Health Care in the United States
• Front Matter
• The Center for the Evaluative Clinical Sciences
• Maps
• Figures
• Tables
• Introduction
  • About Rates in the Atlas
  • Making Fair Comparisons Between Regions
  • Communicating With Us About the Atlas
• Chapter One. The Geography of Health Care in Michigan
• Chapter Two. Acute Care Hospital Resources and the Physician Workforce
  • Acute Care Hospital Resources
  • Acute Care Hospital Beds
  • Hospital Employees
  • Registered Nurses Employed by Acute Care Hospitals
  • The Physician Workforce
  • The Physician Workforce Active in Patient Care
  • Physicians in Primary Care
  • Specialists
  • Chapter Two Table
• Chapter Three. Variations in Hospitalizations for Medical Conditions
  • The Patterns of Hospitalization for Treatment of Hip Fracture
  • Need, Not Hospital Capacity, Drives Hip Fracture Hospitalization Rates
  • Variations in Discharges for Specific Medical Conditions
  • Discharges for Medical Conditions Among Adult BCBSM Members
  • Discharges for Medical Conditions Among Child BCBSM Members
  • Discharges for Medical Conditions Among Michigan Medicare Enrollees
  • Hospital Capacity Matters
  • Hospitalization for Ambulatory Care-Sensitive Conditions
  • Supply of Resources, Access and Continuity of Care and Hospitalizations for Ambulatory Care-Sensitive Conditions
  • The Medical Signatures of Selected Michigan Hospital Service Areas
  • Is More Acute Hospital Care Better?
  • Chapter Three Table
• Chapter Four. The Surgical Treatment of Common Diseases
  • Colorectal Cancer
  • Childbirth
  • Injuries to the Knee
  • Tonsillectomy
  • Middle Ear Disease
  • Cholecystectomy
  • Benign Conditions of the Uterus
  • Back Pain
  • The Surgical Signature
  • Chapter Four Table
• Chapter Five. Coronary Artery Disease
  • Diagnostic Testing for Coronary Artery Disease
  • The Use of Non-Imaging Stress Testing
  • The Use of Imaging Stress Testing in BCBSM Members With Coronary Artery Disease
  • Is There Evidence of Substitution Between Imaging and Non-Imaging Stress Testing?
  • The Evaluation of Left Ventricular Ejection Fraction: the Use of Echocardiography and Nuclear Scanning
  • Echocardiography
  • The Evaluation of Coronary Anatomy: the Use of Coronary Angiography
  • Coronary Angiography
  • Therapeutic Interventions for Coronary Artery Disease
  • Coronary Artery Bypass Grafting
  • Percutaneous Coronary Interventions
  • Total Revascularization
  • The Association between Diagnostic Testing and Cardiac Revascularization
  • What Do These Relationships Mean?
  • The Use of Beta Blockers Following Acute Myocardial Infarction or Cardiac Revascularization
  • The Use of Lipid Lowering Agents following Acute Myocardial Infarction or Cardiac Revascularization
  • Readmission Within Thirty Days of Discharge for Acute Myocardial Infarction or Cardiac Revascularization
  • Chapter Five Table
• Chapter Six. The Intensity of Care in the Last Six Months of Life
  • The Likelihood That Death Will Occur in a Hospital, Rather Than Elsewhere
  • The Likelihood of Being Admitted to an Intensive Care Unit During the Last Six Months of Life
  • Physician Visits During the Last Six Months of Life
  • Primary Care Physician Visits During the Last Six Months of Life
  • Visits to Medical Specialists During the Last Six Months of Life
  • The Likelihood of Seeing Ten or More Physicians in the Last Six Months of Life
  • Chapter Six Tables
• Chapter Seven. Practice Variations and the Use of Prescription Drugs
  • Patterns of Variation in Pharmaceutical Use
  • Treatment of Elevated Cholesterol
  • The Use of HMG Lipid (Statin) Drugs
  • The Use of Angiotensin-converting Enzyme (ACE) Inhibitors and Beta Blockers
  • The Use of ACE Inhibitors Among BCBSM Members with Pharmacy Benefits
  • The Use of Beta Blockers Among BCBSM Members with Pharmacy Benefits
  • The Treatment of Conditions Associated with Gastric Acid Secretion
  • The Use of Proton Pump Inhibitors
  • The Treatment of Allergies
  • The Use of Prescription Antihistamines
  • Treatment of Depression
  • The Use of Selective Serotonin Re-uptake Inhibitors
  • Treatment of Anxiety
  • The Use of Anti-Anxiety Drugs
  • Pediatric Antibiotics
  • Pediatric Antibiotics
  • The Use of Low and High Cost Antibiotics by Children
  • Treatment of Attention Deficit Disorders In Children
  • Use of Attention Deficit Hyperactivity Disorder Drugs by Children
  • Chapter Seven Table
• Chapter Eight. The Problem of Unwanted Variations
  • The Underuse of Effective Medical Care
  • Screening for Breast Cancer
  • Annual Eye Examinations for Diabetics
  • Beta Blockers and ACE Inhibitors for Heart Attack Patients
  • Beta Blockers at Discharge
  • The Use of ACE Inhibitors
  • Why is There Underuse of Effective Services?
  • Underuse and Overuse of Surgery and The Quality of Clinical Science
  • The Overuse of Discretionary Surgery
  • Discretionary Surgery and the Question of Which Rate is Right
  • Shared Decision Making and the Right Rate for Discretionary Surgery
  • Shared Decision Making and the Rate of Surgery for Benign Prostatic Hyperplasia
  • Shared Decision Making and the Rate of Surgery for Stable Angina
  • Shared Decision Making and the Rate of Surgery for Lumbar Disc Disease
  • Shared Decision Making and the Rate of Surgery for Spinal Stenosis
  • Overuse and Underuse of Prescription Drugs
  • Overuse and Underuse of Hospitals for Medical Conditions
  • Overuse and Underuse of End of Life Care
  • What Does Greater Health Care Spending Buy?
  • Michigan Conforms to the National Pattern
  • The Challenge of Practice Variations
  • Chapter Eight Table
• Appendix on Methods

Dartmouth Atlas of Health Care in Michigan Working Group

Kristen K. Bronner, MA

Megan McAndrew Cooper, MBA, MS

F. L. Lucas, PhD

Sandra M. Sharp, SM

Andrea E. Siewers, MPH

Library of Congress Cataloging-in-Publication Data

Dartmouth Medical School. Center for the Evaluative Clinical Sciences.

The Dartmouth Atlas of Health Care in Michigan / The Center for the Evaluative Clinical Sciences, Dartmouth Medical School.

1. Medical care—United States—Marketing—Maps. 2. Health facilities—United States—Statistics. I. Title.

© 2000 The Trustees of Dartmouth College

All rights reserved. The reproduction or use of this book in any form or in any information storage or retrieval system is forbidden without the express written permission of the publisher.

Printed in the USA