A Tool for Identifying Unnecessary Medical Procedures Proves Itself

Demonstration project on using the Dartmouth Atlas of Health Care

From 1997 to 1999, efforts by coalitions of businesses, health systems and providers in Muncie, Ind.; Topeka, Kan.; and Milwaukee worked to improve local health care using the Dartmouth Atlas of Health Care.

The Atlas (developed by Dartmouth Medical School under RWJF grant ID# 022477) is a computerized geographical information system that permits comparisons of health resources, expenditures, and utilization rates among different regions.

In the project, the coalitions worked closely with Dartmouth Medical School and the Hospital Research and Educational Trust (HRET), an affiliate of the American Hospital Association (AHA), which publishes the Atlas.

Key Results

  • The Milwaukee coalition organized a team of local cardiac specialists who represented participating health systems to study utilization rates and the potential for shared decision-making.
  • The Muncie site — GM-UAW (General Motors-United Auto Workers) Health Care Initiatives, for GM plants — developed a learning process by using the Atlas to identify demographically similar areas where rates of open-heart surgery were below the national average.
  • A statewide coalition of large employers, hospitals and health systems in Kansas used Atlas data to educate employees about treatment variations and how to decide on an appropriate course of treatment.
  • The Hospital Research and Educational Trust and the Dartmouth Medical School produced and published A Health Care Purchaser's Guide to Using the Dartmouth Atlas.
  • No site was able to measurably change utilization rates for the procedures under study during the grant period.

Funding

The Robert Wood Johnson Foundation (RWJF) supported this project through a grant of $100,228 to the Hospital Research and Educational Trust.