Contents

• Dedication
• Maps
• Figures
• Tables
• Chapter One. Variations in the Use of Acute Care Hospital Services
  • Small Area Analysis
  • The Surgical Signature
  • The Medical Signature
  • Sources of Variation
  • Notes on the Data
  • The Geography of Health Care in Virginia
  • Chapter One Table
• Chapter Two. Acute Care Hospital Resources and Medicare Expenditures in Virginia
  • Acute Care Hospital Beds
  • Acute Care Hospital Employees
  • Registered Nurses Employed in Acute Care Hospitals
  • Medicare Spending
  • Medicare Reimbursements for Noncapitated Medicare
  • Medicare Reimbursements for Inpatient Services
  • Medicare Reimbursements for Outpatient Services
  • Medicare Reimbursements for Professional and Laboratory Services
  • Medicare Reimbursements for Home Health Services
  • Chapter Two Table
• Chapter Three. The Physician Workforce in Virginia
  • The Physician Workforce Active in Patient Care
  • Physicians in Primary Care
  • Specialist Physicians
  • Cardiologists
  • Cardiothoracic Surgeons
  • General Surgeons
  • Obstetrician/Gynecologists
  • Orthopedic Surgeons
  • Radiologists
  • Urologists
  • Physicians in Residency Training Programs
  • Chapter Three Table
• Chapter Four. The Surgical Treatment of Common Diseases
  • Colectomy
  • Coronary Artery Bypass Grafting
  • Percutaneous Transluminal Coronary Angioplasty
  • Carotid Endarterectomy
  • Cholecystectomy
  • Primary Hip Replacement
  • Primary Knee Replacement
  • Lumbar Discectomy
  • Mastectomy for Breast Cancer
  • Hysterectomy for Benign Conditions of the Uterus
  • Births
  • Cesarean Sections
  • Vaginal Birth After Cesarean Section
  • Transurethral Prostatectomy
  • Radical Prostatectomy
  • Chapter Four Tables
• Chapter Five. Quality of Care: The Use of Preventive Services
  • Immunizations and Screening Examinations
  • Vaccination for Pneumococcal Pneumonia
  • Screening for Breast Cancer
  • Screening for Colorectal Cancer
  • Secondary Prevention Services for Diabetics
  • Annual Eye Examinations for Diabetics
  • Annual HgbA1c Monitoring for Diabetics
  • Blood Lipids Testing for Diabetics
  • The Preventive Care Profiles of Hospital Referral Regions
  • Hospitalizations for Ambulatory Care-Sensitive Conditions
  • Supply of Resources, Access to Care, and Hospitalizations for Ambulatory Care-Sensitive Conditions
  • Chapter Five Table
• Chapter Six. The Experience of Death in Virginia
  • The Likelihood That Death Will Occur in a Hospital, Rather Than Elsewhere
  • The Likelihood of Hospitalization During the Last Six Months of Life
  • Days in Hospitals During the Last Six Months of Life
  • The Likelihood of Admission to Intensive Care During the Last Six Months of Life
  • The Likelihood of Spending Seven or More Days in Intensive Care During the Last Six Months of Life
  • The Likelihood of Admission to Intensive Care During the Terminal Hospitalization
  • Reimbursements for Inpatient Care During the Last Six Months of Life
  • Reimbursements for Intensive Care During the Last Six Months of Life
  • Chapter Six Table
• Chapter Seven. Which Rate is Right? How Much is Enough? and What is Fair?
  • I. Islands of Rationality
  • II. Setting Limits on Hospital Capacity
  • III. Setting Limits on the Physician Workforce
  • IV. Focusing the Debate: A Summary Statement
• Appendix on Methods
• Endnote

The views expressed in this publication are strictly those of the authors and do not necessarily represent official positions of the American Hospital Association.

Library of Congress Cataloging-in-Publication Data

Dartmouth Medical School. Center for the Evaluative Clinical Sciences.

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

ISBN 1-55648-289-2

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

Catalog no. 044800

© 2000 The Trustees of Dartmouth College

Printed in the USA