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The Dartmouth Atlas of Health Care 1999

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Serious and widespread quality problems exist throughout American medicine including underuse, overuse and misuse. Health care provided to residents of the United States is highly dependent on two factors: the capacity of the local health care system (which influences how much care is provided) and the practice style of local physicians (which determines what kind of care is provided). Variations in the intensity of use of hospitals, differences in care at the end of life, and the nearly random patterns of elective surgery all raise questions about the outcomes and value of care. This third edition of the Dartmouth Atlas of Health Care considers what geographic variations imply about the quality of medical care. Each chapter of the Atlas focuses on a different aspect of health care in the United States with specific attention to geographic variation. Some examples of chapter topics include the distribution and utilization of acute care hospital resources and the physician workforce and a summary assessment of the quality of care in fee-for-service Medicare. The 1999 Atlas concludes that to improve overall quality, it is necessary to improve the quality of clinical science, the quality of clinical decision-making, and the quality of medical resource allocation.