The Care of Patients with Severe Chronic Illness: A Report on the Medicare Program by the Dartmouth Atlas Project

Publication Date:

Publisher: Center for the Evaluative Clinical Sciences, Dartmouth Medical School

Author(s): Center for the Evaluative Clinical Sciences and Dartmouth Medical School

Research Area: Health

Type: Report

Abstract:

This report by the Dartmouth Atlas Project scrutinizes the current system of chronic care management, highlighting its waste and providing recommendations on how to improve both quality and efficiency. Chapter one explains why differences in the supply of resources drives demand for utilization of services in managing chronically ill patients. The chapter reviews research that suggests that more expensive care and greater resource utilization is associated with poorer quality, worse outcomes and lower satisfaction with care. Researchers also studied Medicare claims data for 4,300 hospitals in 306 regions and compared every region to three that provided high-quality/low-cost care. Chapters two and three report their finding that disparities in Medicare spending on chronically ill enrollees exist among states and regions. Additionally, Medicare spending could be reduced by 30 percent if the resources and utilization habits of efficient providers of chronic care were adopted by all providers of such care. Chapter four provides information on accessing the Dartmouth Atlas reports and database. The final chapter examines the problem of overuse of acute care hospitals in caring for chronically ill patients. To fix inefficiencies in our system of chronic care management, researchers recommend that resources be redirected away from acute care and invested in infrastructures that can better coordinate care outside of hospitals.