Draft:Dartmouth Atlas of Health Care

The Dartmouth Atlas of Health Care is a research project at the Dartmouth Institute of Health Policy & Clinical Practice (formerly the Center for the Evaluative Clinical Sciences at Dartmouth). Founded in the early 1990s by Dr. John Wennberg and colleagues, the Atlas provides comprehensive data and analysis that examines variations in health care utilization, spending, and quality across different regions and hospitals in the United States. The project aims to provide insight into patterns of health care delivery and outcomes, with the goal of improving health care policy and practice.

Description
The Atlas uses claims databases, primarily—but not limited to—fee-for-service Medicare, to analyze how medical resources are distributed and used, revealing variations in health care delivery and outcomes that are not always justified by differences in illness burden or patient preferences. It examines a wide range of factors, including hospitalizations, procedures, tests, costs, and end-of-life care, among others.

The project's findings have highlighted the substantial differences in health care utilization and spending across the country, as well as the lack of correlation between increased spending and better outcomes. It has been influential in the discussion on health care reform and has provided important evidence to help policymakers, the media, health care analysts, and other stakeholders improve their understanding of the efficiency and effectiveness of our health care system. These data form the foundation for many of the ongoing efforts to improve health and health systems across America.

With primary support from the Robert Wood Johnson Foundation, the Atlas project has produced more than 60 reports and longitudinal datasets spanning more than 15 years addressing a wide range of issues facing U.S. health care.

Criticisms
The methods used by the Atlas project have received criticism, particularly during the period leading up to the Affordable Care Act, primarily concerned with the project's use of end-of-life patients for risk adjustment. These critiques received media attention, prompting a back-and-forth exchange with the New York Times,  among other responses. Other researchers argued that regional variations could be explained by poverty, and that policy changes in response to Atlas findings would end up hurting the poor, an argument that was explored by several experts.

Future
More recently, the Atlas project used county-level data from the New York Times to explore variations during the COVID-19 pandemic and plans a Health Equity Atlas to look at variations in health care utilization and outcomes due to racial and economic inequities.