Take a look at the website for the Dartmouth Atlas of Healthcare. There is an interactive site, where you can pick out specific utilization measures for specific geographic areas or individual hospitals (http://www.dartmouthatlas.org/), and there is also an area of the site where you can download Excel or pdf files with the data (http://www.dartmouthatlas.org/downloads.aspx) – this latter site much easier to navigate and I strongly recommend using it. Pick an example of variation in utilization that you believe is unwarranted and describe the range of factors that are likely to contribute to the differences among areas (or hospitals). Examples utilization rates on the site include:
• Care of chronically ill patients during the last two years of life (http://www.dartmouthatlas.org/tools/downloads.aspx?tab=40)
• Selected surgical discharge rates (http://www.dartmouthatlas.org/tools/downloads.aspx?tab=41)
• Selected medical discharge rates (http://www.dartmouthatlas.org/tools/downloads.aspx?tab=41)
• Children’s health care in Northern New England, 2007-10 (http://www.dartmouthatlas.org/tools/downloads.aspx?tab=35)
• Prescription drug use, 2010 (http://www.dartmouthatlas.org/tools/downloads.aspx?tab=35)
Please look at utilization levels, not variation in mortality, costs/spending/reimbursement or resource inputs that are reported in some files or tables. While you can write about some of the “quality” measures (primary care access and quality or post discharge events) if you have an abiding interest in these topics, I would much prefer you to focus on variation in rates of utilization – also please note that these “quality” measures will be more difficult to tie into the discussions we had in class.
After discussing the range of factors that affect variation in rates, pick one contributing factor that you think is important (or that you think something can be done about it) and make some suggestions about what might be done to reduce variation. Be specific and detailed in your suggestions, including who ought to do what to whom. Be realistic, don’t make suggestions that cannot be implemented because of technical, financial, or political considerations. This is a conceptual piece and not a research paper, but footnote sources of ideas from others that you use for the causes of variation (or the suggested solutions if the ideas come from a specific source).
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