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.  This 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.

One notable finding is that Vermont practitioners are the most conservative in the country in using intensive care unit (ICU) treatments for Vermonters at the end of life. The two following displays reveal that few Vermonters spend more than seven days in any ICU in the last six months of their lives, and for those that do spend time in an ICU, these stays are brief (Vermont is indicated by the red dot).  

The second notable finding illustrated on the pages below is that although Vermont is a relatively low user of medical resources at the end of life, there is significant variation across the state in terms of hospitalization, use of intensive care, and enrollment in home health and hospice services.

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