Take a look at the website for the Dartmouth Atlas of Healthcare. There is an area of the site where you
can download Excel or PDF files with the data from Dartmouth Atlas.
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 of utilization rates on
the site include:
Care of chronically ill patients during the last two years of life, Care of Chronically Ill Patients
Selected surgical or medical discharge rates
Children’s healthcare in Northern New England, 2007-10 Children’s Healthcare
Prescription drug use, 2010 Prescription Drug Use
You can use the graphical interface on the website to explore topics if you want, but for the data you
actually use in your paper, use the downloadable Excel files found at the links listed above.
www.dartmouthatlas.org/interactive-apps/
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) 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).
You may work as a team on this memo, with up to three people on a team. While you are not required to
work on a team, I encourage you to do so since it often engenders broader and more creative thinking for
the paper. After the live session, you can watch the video below for more details on the paper assignment.
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