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| Dartmouth Atlas of Health Care | |
|---|---|
| Name | Dartmouth Atlas of Health Care |
| Established | 1996 |
| Location | Hanover, New Hampshire |
| Type | Health policy research project |
Dartmouth Atlas of Health Care The Dartmouth Atlas of Health Care is a long‑running research project and published resource that documents variations in medical resources, utilization, and outcomes across United States hospital referral regions and health systems. It synthesizes administrative data to produce comparative analyses used by policymakers, clinicians, and scholars interested in health care delivery, cost, and quality across institutions such as Harvard Medical School, Mayo Clinic, Johns Hopkins Hospital, and Cleveland Clinic. The project has been cited in reports from Centers for Medicare & Medicaid Services, Congressional Budget Office, World Health Organization, and major media outlets like The New York Times, The Washington Post, and The Wall Street Journal.
The Dartmouth Atlas compiles nation‑wide metrics on utilization, spending, capacity, and outcomes tied to places like Boston, Chicago, Los Angeles, New York City, and Houston, presenting findings by hospital referral region and provider networks including Massachusetts General Hospital, Stanford Health Care, and UCLA Health. It publishes data products comparable to reports from Agency for Healthcare Research and Quality and analytical work by National Institutes of Health researchers, informing debates in venues such as United States Congress, Federal Reserve System, and policy centers like Brookings Institution and Kaiser Family Foundation.
The project grew out of research at Dartmouth College and the Dartmouth Institute for Health Policy and Clinical Practice in the 1990s, influenced by earlier work at institutions including University of Rochester, University of Pennsylvania, and University of Michigan. Early leadership and collaborators included scholars associated with New England Journal of Medicine publications and presentations to organizations such as American Medical Association and American Hospital Association. Major publications coincided with health policy milestones such as the passage of the Patient Protection and Affordable Care Act and subsequent implementation by Centers for Medicare & Medicaid Services.
Analyses rely heavily on administrative claims from Medicare fee‑for‑service programs, supplemented with data from Medicaid, commercial insurers, and registries affiliated with Society of Thoracic Surgeons and other specialty societies. The methodology builds on geographic definitions like hospital referral regions (HRRs), drawing on coding systems such as International Classification of Diseases and payment files used by Centers for Medicare & Medicaid Services. Statistical approaches mirror practices in work published by Journal of the American Medical Association and analyses conducted by researchers at RAND Corporation and Urban Institute.
Seminal Dartmouth Atlas reports documented wide regional variation in end‑of‑life care intensity, hospital readmissions, and per‑capita Medicare spending across regions including Miami, Minneapolis, Phoenix, and Seattle. Notable outputs include comparative tables and monographs cited alongside research from Institute of Medicine (now National Academy of Medicine), studies in Health Affairs, and systematic reviews in Cochrane Library. Findings have been incorporated into influential works by authors such as those published by Oxford University Press and Cambridge University Press on health services research.
Policymakers at U.S. Department of Health and Human Services, analysts at Congressional Budget Office, and program designers at Centers for Medicare & Medicaid Services have used Atlas data to design payment reforms, accountable care organization pilots like those run by Medicare Shared Savings Program, and quality measurement initiatives linked to Hospital Readmissions Reduction Program. Health systems including Geisinger Health System, Intermountain Healthcare, and academic centers such as Yale New Haven Hospital have referenced Atlas findings when redesigning care models, coordinating palliative care teams, and implementing care‑management programs.
Critiques have come from academicians at University of California, Berkeley, Columbia University, and London School of Economics pointing to challenges in attributing variation solely to supply or practice style rather than patient preferences or unmeasured confounding. Stakeholders from American Hospital Association, provider groups like American College of Physicians, and insurers including UnitedHealth Group and Aetna have debated the policy implications of Atlas claims, especially regarding implicit assumptions about efficiency, regional adjustment, and the use of Medicare data to generalize to privately insured populations.
The Dartmouth Atlas has collaborated or been compared with projects such as the Commonwealth Fund scorecards, Kaiser Family Foundation analyses, Agency for Healthcare Research and Quality databases, and research consortia at Johns Hopkins Bloomberg School of Public Health and Harvard T.H. Chan School of Public Health. Related initiatives include bundled payment demonstrations by Centers for Medicare & Medicaid Services Innovation Center, comparative effectiveness research supported by Patient‑Centered Outcomes Research Institute, and international benchmarking efforts by Organization for Economic Co‑operation and Development.
Category:Health policy