I guess it shouldn't surprise me, but when I looked at the information in the April, 2008 Dartmouth Atlas of Health Care, I was taken aback. The Atlas looked at the outcomes of chronic disease care and tracked these outcomes against the resources attached to them. It was found that when it comes to getting care for a chronic disease, geography matters. Depending on where they live and what hospital or health care organization they use, these patients receive very different care.
These variations in care appear not to be linked to how sick the patients are, and, it turns out that the places where more resources are available are not the places demonstrating better care and better health outcomes.
This article focuses on supply sensitive care for patients with severe chronic illness in the last 2 years of their life. Areas that had offered more resources actually had a slightly higher mortality rate (over a period of up to 5 years) for patients following acute myocardial infarction, hip fracture, and colorectal cancer diagnosis--with no difference in functional status. As well, in higher-resourced settings, patients reported worse access to care and greater waiting times, with no difference in patient-reported satisfaction with care.
Paul Batalden's quote is so appropriate: "Every system is perfectly designed to get the results it gets."
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