Evaluating the Efficiency of California Providers in Caring for Patients with Chronic Illnesses

Overview The Dartmouth Institute for Health Policy and Clinical Practice (TDI) has created a publicly available source of data that provides researchers, payers, regulators, and innovators with metrics that quantify temporal and regional patterns of health care spending and utilization in the United States. Using CMS Medicare claims data (mostly for age >64 enrollees), Atlas researchers built cohorts (“denominators”) and numerous measures or events (“numerators”) which were then used to calculate rates either by geography or for patients assigned to specific hospitals. These rates, which are calculated consistently across time and place, provide researchers with opportunities to evaluate spatial and temporal variation/trends. This entry contains California-specific rates for a variety of spending, utilization, and resource use measures related to end-of-life care for fee-for-service (FFS) Medicare beneficiaries who died during 1999-2003 and who were diagnosed with a severe chronic illness. Examples of spending and utilization measures include total Medicare spending, days in hospital, days in intensive care, number of physician visits, number of medical specialist visits, and percentage of deaths occurring in a hospital. Examples of resource use measures include hospital beds, ICU beds, and physician labor. Rates are calculated over either the last two years (spending and resource use measures) or last six months (utilization measures) of life. Rates are provided at the hospital referral region (HRR) and hospital level, and all rates have been adjusted for age, sex, race, and type of chronic illness using regression models. Users downloading data should review the methods sections of the related publication for context. All reports in the Dartmouth Atlas of Health Care series are available from the National Library of Medicine https://www.ncbi.nlm.nih.gov/books/NBK584737/