Appendix A: Dartmouth Atlas of Health Care Utilization Indicators
The Dartmouth Atlas of Health Care ( www.dartmouthatlas.org) is an interactive website that provides
data on care utilization for hospitals. Utilization data includes Medicare claims; demographic data
includes gender, race, and select socio-economic indicators. All data has been organized into geographic
hospital services areas (HSAs) and hospital referral regions (HRRs) according to a specific methodology.
Claims data is grouped into sections related to care of chronic illness in the last two years of life:
Medicare reimbursements, hospital and physician capacity, quality care, hospital use, end-of-life care, and
physician care service areas. Data is presented in tables, graphs, and customizable maps. National
averages and percentile breakdowns (10th, 50th, and 90th percentiles) are also available. A list of the
utilization measures that can be found using this resource appears on the following page.
While this source is extensive and widely used, it has some limitations: (a) data is available for the period
1996–2005 only; (b) some metrics are provided in aggregate (e.g., 2001–2005) rather than by year (e.g.,
2001, 2002...); (c) the dataset includes Medicare-enrolled decedents only, so comparisons to other
populations may not be appropriate; and (d) data have been allocated according to a specific
methodology and are not likely to match internal utilization figures for a given facility. Researchers have
identified other strengths and weaknesses of the data.
Nearly all utilization indicators in the Dartmouth Atlas are available by gender and race, and for the
years 1996–2005. Certain indicators are available for the summary period 2001–2005 only. Details can
also be obtained by state, hospital service area, or hospital referral region.
Please note that the following list only includes a sample of utilization indicators. A complete list of all
indicators, including those not shown here (e.g., demographics or Medicare reimbursements) is available
22 Bach PB, Skinner J, Staiger D, Fisher ES. The debate over regional variation in health care spending. New England Journal of Medicine, 2010;
362: 7. Accessed November 23, 2010 from www.nejm.org.