PDF of QR 2008

Contents

Executive summary

Overview

Ch1: Healthcare Utilization

            Inpatient care

            Outpatient care

            Service Area

Ch2: Measuring Quality of Care

Inpatient Care

Pediatric Care

Prevention Indicators

Patient Safety

NCQA HEDIS

Ch3: Chronic Illness in Vermont

   Diabetes -  VHR

   Diabetes AHRQ Indicators

   VPQ Learning Community

   Dartmouth Atlas

Ch4: MRSA

Ch5: End of Life Care

   Care at End of Life

   Dartmouth Atlas

Ch6: Other Reports

Glossary

QR Site Map

Contact Us

Dartmouth Atlas

The Dartmouth Atlas http://www.dartmouthatlas.org is a project of the Dartmouth Institute for Health Policy and Clinical Practice.  The project has been active since 1993 and is currently funded by a grant from the Robert Wood Johnson Foundation.  The principal authors are Jack Wennberg, Elliot Fisher, David Goodman and Jonathan Skinner.  The Atlas reports on variations in how medical resources are distributed and used in the US.  The project employs a population-based, small area variation strategy, and uses Medicare claims data.  The 2008 Atlas specifically focuses on Medicare beneficiaries with chronic illness who were in the last 2 years of life.  The population of beneficiaries studied had at least one of nine chronic illnesses, two-thirds of which were cancer, heart failure or chronic lung disease like emphysema and chronic bronchitis. The Atlas authors chose to focus on this large group of patients at the end of their lives because 75% of all Medicare spending is on chronic illnesses and one-third of all Medicare dollars occur during the last 2 years of life.

From a national perspective, the key findings of the 2008 Atlas are:

•        Misplaced financial incentives result in over-use of acute care hospital services and excess of specialty care;

•        The driver of utilization is not cost per service, rather number of services;

•        Service utilization is based on availability of beds and prescription drugs, not on severity of illness;

•        Providers and patients have a shared belief that more services produce better care, and this belief leads to more beds and services creating their own demand;

•        “In healthcare it matters where you get your care”. 

The authors’ recommendations include:

•        More research on when to hospitalize, when to avail other services

•        No need for more alternative beds; hospital spending is higher in regions with more rehab units and SNFs;

•        Hospice care was an exception; hospital spending is lower in regions with more hospice. 

This section of the Vermont Quality Report includes some Vermont-specific findings that VPQ has gleaned from the 2008 Dartmouth Atlas.  The first set of findings compares healthcare utilization in Vermont to other states for all Medicare beneficiaries.  The second set of findings focus on elderly Medicare beneficiaries who lived in Vermont, who had chronic illness and died from their illness. This second view compares resource allocation and patient experience at several of Vermont’s hospitals and a few institutions in bordering states.   The findings are based on all the Medicare expenditures in their last two years of life.

The salient findings in the 2008 Atlas regarding the care Medicare beneficiaries receive in Vermont are:

1.  Relative to other states in the U.S., utilization of resources is low;

2. Utilization of hospitalization for both medical care and surgical care is very low when an outpatient setting is an appropriate alternative; and

3. Even though utilization as a state is conservative, there is considerable variation within Vermont in Medicare spending, resource allocation and patient experience at the end of life.

For a summary presentation of the 2008 Dartmouth Atlas regarding the care Medicare beneficiaries receive in Vermont (click here).