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The Dartmouth Atlas Controversy: What does it mean for your reporting?

The Dartmouth Atlas Controversy: What does it mean for your reporting?

Picture of Barbara Feder Ostrov

Who knew that the Dartmouth Atlas could arouse such passion? Many journalists have been trained to see the influential dataset as one of their most reliable sources for reporting on health care costs and regional differences in how health care is delivered in the United States. The Dartmouth Atlas' methods has recently come under fire, so in this post, I'll help you sort through the current controversy (there have been others in the past) and how it might affect your reporting.

Here's what the New York Times' Gardiner Harris wrote in a Feb. 17 article that lobbed the opening salvo:

An article in The New Yorker magazine last year written by Dr. Atul Gawande that used the Dartmouth Atlas as its organizing principle became required reading in the White House last year.

But an analysis written in The New England Journal of Medicine by Dr. Peter B. Bach, a physician and epidemiologist at Memorial Sloan-Kettering Cancer Center in Manhattan, suggests that much of the Dartmouth Atlas is flawed and that it should not be used to compare the relative efficiency of hospitals.

The arguments are arcane, but were health overhaul legislation ever to pass, they could have profound effects on how medicine is delivered and paid for in the United States. Some proposals in Congress called for using analyses like those found in the Dartmouth Atlas to begin spending less money on regions where medical care is especially costly, including places like New York City.

Health bloggers quickly jumped into the fray, with some cudgeling the Atlas and others, like Maggie Mahar, defending it. Here's Atul Gawande's response.

Jordan Rau's deeply reported November 2009 Kaiser Health News account  of earlier criticisms leveled at the Dartmouth Atlas provides some context for the current skirmish over the Atlas' methods:

A small group of health care experts raising doubts about Dartmouth's methods, which focus on comparing how hospitals treat Medicare patients in their final two years of life. It is from those studies that Dartmouth came to its most far-reaching conclusion: that too much medical care can actually hurt patients rather than help them. But the skeptics say the way hospitals treat Medicare patients can't be translated into firm conclusions about the country's overall health spending and trends.

Dartmouth researchers say that even when you take the socio-economic levels of patients and sicker populations into account, some hospitals spend far more than others without good reason. And they say their studies show Medicare spending is a good indication of how hospitals generally operate.

So there you have it: an ongoing (and complex) disagreement over how much the Dartmouth Atlas can really explain about health care costs and whether proponents of health reform should be looking at the Dartmouth Atlas at all. So should you change how you think about using the Dartmouth Atlas in your own reporting?

I asked GoozNews blogger Merrill Goozner, who recently opined on the Dartmouth Atlas, what lessons journalists should take away from this debate.

The Atlas "measures what it measures" and it's important for reporters not to over interpret the data. Regional variations in how healthcare is provided are important but not defining," he told me. "It's like any major statistic – it can be useful or it can be misleading if you draw the wrong conclusions from it."

Say a reporter finds excessive Medicare claims from a certain provider or type of procedure. That's not the story, that the community is an outlier, Goozner said. "You got to go out and figure out why, and the answer can be very different in different communities. In Miami, there's a lot of fraud."

How have you used the Dartmouth Atlas in your reporting? Share your work and thoughts in the comments below. You need to be a registered member of Center for Health Journalism Digital to leave a comment, so if you haven't joined yet, click here. It's easy, quick and free. You can follow us on Twitter, too, @ReportingHealth.

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Picture of Barbara Feder Ostrov

UPDATE: A new Dartmouth Atlas article by Gardiner Harris and Reed Abelson has some health policy bloggers (and even one of their sources) riled up. Maggie Mahar provides a great overview of the controversy at her Health Beat blog. It's a must-read if you're planning on using the Dartmouth Atlas in your own reporting.

Picture of Barbara Feder Ostrov

And the debate over the NYT's coverage of the Dartmouth Atlas continues over at The Health Care Blog with Matthew Holt's latest analysis. Be sure to check out the spirited conversation in the comments section, which includes react from Gardiner Harris.

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