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Chapter 7: Profile of Health Care in VT as Reported in National ReportsExperience has shown that patterns of care in Vermont do not necessarily follow national trends. Amid the broad summary statements of national reports are often more relevant state-specific findings. This chapter of the Quality Report provides a summary of Vermont-specific findings from two external reports: the 2008 Dartmouth Atlas and the Agency for Healthcare Research and Quality's 2007 State Snapshots.
Utilization of Care at End of Life: Dartmouth Atlas
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.
Utilization of health care services in Vermont at the end of life is markedly different from the rest of the country as a whole. At the end of life, Vermonters are hospitalized less than in other parts of the country. Vermonters visit their physicians less and experience more continuity of care than elsewhere. They are more apt to avail themselves of home health and skilled nursing facilities, but less likely to be enrolled in hospice programs. These initial revelations about care patterns in Vermont should give pause to local policy makers if they assume that so goes the country, goes Vermont.
Health Care Quality Dashboard: 2007 AHRQ State Snapshots
In 2007, AHRQ developed a “State Snapshot” to help State policymakers better understand healthcare quality and disparities specific to their state. The design is a “performance meter” which provides a quick, high-level overview of the healthcare quality in various settings and types of care. Each performance meter is based on composite measures of quality which highlight a state’s strengths and weaknesses.
In the 2007 State Snapshot, Vermont excels on performance measures in Prevention, Ambulatory Care, Diabetes, Maternal and Child Health, and Respiratory Diseases. Vermont has shown improvement in Home Health Care Measures. Nursing home care measures are portrayed as a weaker performing area in Vermont.
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