Dartmouth Atlas:  Chronic Illness

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.

This section of the Vermont Quality Report includes some Vermont-specific findings that VPQ has gleaned from the 2008 Dartmouth Atlas.  These findings focus on elderly Medicare beneficiaries who lived in Vermont, who had chronic illness and died from their illness. 

The first set of findings compares healthcare utilization in Vermont to other states for all Medicare beneficiaries with a selection of common chronic illness.  Vermont practitioners are among the lowest users (indicated on the graphs with the lowest red dot) of hospitalization for these conditions as is evident in the following displays.  

COPD is chronic obstructive pulmonary disease, chiefly chronic bronchitis and emphysema.

Other chronic conditions presented include: asthma, diabetes, and congestive heart failure. 

The second set of findings on the pages below 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 notable conclusion is that though the use of hospital services is relatively low in the state compared to the region and the country as a whole, there is significant variation within the state in terms of Medicare spending, resource allocation and patient experience.

For a summary of the 2008 Dartmouth Atlas regarding the care at the end of life received in Vermont (click here).