Atlas shows widespread variations in care
The third edition of the Dartmouth Atlas of Health Care — 1999 reveals the persistence of great variation in health care delivery and cost in 306 hospital referral regions. Here are some of the findings from the Atlas study, based on fee-for-service Medicare data:
• Greater capacity of hospital beds leads to higher rates of hospitalization. The medical discharge rate is 40% higher in areas with a high supply of hospital beds compared to those with the lowest supply.
• Delivery of preventive care was inconsistent. Regions with high rates for mammography, for example, may have lapsed in the area of diabetic eye exams.
• Regions varied widely and fell far short of national health care goals in preventive care. For example, two-year mammography rates for Medicare enrollees between 65 and 69 ranged from 12.5% to about 50% with an average rate of 28.3%.
• Preventive care was not related to access to primary care physicians or continuity of care.
• Coronary artery bypass grafting ranged from 87% above the national average to 50% below it. Both angioplasty and bypass surgery grew rapidly, from about 70,000 total procedures in 1984 to more than 380,000 in 1996.
• Care at the end of life varied dramatically, as well, with patients in some regions having less than nine visits with physicians in the last six months of life and others averaging close to 50 visits in that time frame.
1. According to David Wennberg, MD, MPH, director of the Center for Outcomes Research and Evaluation at Maine Medical Center in Portland, ME, how should physicians address the problem of variation in preventive care?
A. ensure that medical training is
uniform
B. improve physician education on
clinical guidelines
C. create a more systematic
approach to care with flow sheets
or electronic medical records
D. variation is an inevitable aspect of
medical care
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