Newest Dartmouth Atlas of Health Care due out soon

Posted 10/12/00

Publication of the Dartmouth Atlas of Musculoskeletal Health Care, the 18th book in the Dartmouth Atlas project, is expected by Oct. 20. The project's recent publications include the Dartmouth Atlas of Cardiovascular Health Care, the Dartmouth Atlas of Vascular Health Care, and the Dartmouth Atlas of Health Care in Michigan.

The Dartmouth Atlas is produced by a working group headed by John E. Wennberg, the Peggy Y. Thomson Professor of the Evaluative Clinical Sciences at Dartmouth Medical School. Wennberg is nationally and internationally recognized for his pioneering work in medical epidemiology and particularly for his development, with Alan Gittelsohn, of the methodology known as small area analysis. Wennberg is the director of the Center for the Evaluative Clinical Sciences at Dartmouth.

The Dartmouth Atlas project began with a grant from the Robert Wood Johnson Foundation in 1993. The project's original aim was to define naturally occurring market areas of health care in the United States, in order to inform regulators who were then contemplating regional insurance cooperatives. Although that plan failed, the project used the definitions of these naturally occurring markets to measure the distribution of health care resources and utilization. It used the Medicare claims databases for both inpatient and outpatient care, as well as data files fromsources like the American Medical Association and the American Hospital Association.

In 1996 the project published the first atlas in the series. It focused on variations in health care resources and utilization, using such measures as hospital beds per 1,000 residents and rates of surgery per 1,000 Medicare enrollees. Later editions in 1998 and 1999 added measures like the experience of Medicare enrollees in the last six months of life and the use of common preventive interventions such as pneumonia vaccinations in the Medicare population. The Atlas project has consistently revealed that there is little coherence in American medicine. The care you receive is more likely to be a function of where you live and the doctor you consult, rather than the result of commonly-shared information about what works and what informed patients actually want.

In September 2000, the Dartmouth Atlas web site was launched. It contains information about Atlas publications and the entire text and data tables from the 1998 edition. The project's aim is to make its findings as widely and as cheaply available as possible; this aim is supported by an additional five-year grant from the Robert Wood Johnson Foundation.