Dartmouth_Report_Cover_300p Click on image above to view or download a PDF of the Dartmouth Atlas Project report.

To fulfill our mission of improving the care of older adults, it is critical to know what is working—and what is not—when it comes to health care for the nation’s growing number of older people. That is why The John A. Hartford Foundation supported a new report from the Dartmouth Atlas Project titled Our Parents, Ourselves: Health Care for an Aging Population.

"This report is really about success," says Terry Fulmer, PhD, RN, FAAN, president of The John A. Hartford Foundation. "Life expectancy has almost doubled since the 1900s, from 40 years to 80 years today. The number of adults over age 65 also is projected to almost double in the coming decades, from 43.1 million in 2012 to 83.7 million by 2050. This is truly remarkable and something to celebrate. However, we now need to achieve the same level of success in meeting the care needs of this growing aging population."

The Dartmouth Atlas report should help. In fact it should be required reading for health system leaders, advocates, and policymakers. It can help them understand the composition of Medicare beneficiaries in their communities, those beneficiaries’ experience of care, and whether they are receiving evidence-based health care along a number of dimensions directly meaningful to older adults and their families. For example, the report looks at the number of unique clinicians that patients see on average, as well as end-of-life treatments, such as late hospice referral and the number of days spent in intensive care.

Based on 2012 Medicare data, this report card is helpful because it breaks down by geographic region where the United States is making progress in patient-centered care for older adults and where improvements are needed. It also breaks new ground, sharing data that has never been public before, including:

  • Older adults with two or more chronic conditions spent 33 days—or just over one month of the year—in contact with the health care system (in the hospital, at a doctor’s office, or at a lab visit).
  • The average Medicare beneficiary was in contact with the health care system on 17 days. Looking at the data by geographic region, the range spanned from 10.2 days in Lebanon, N.H., to 24.9 days in East Long Island, N.Y.
  • 18.4 percent of older adults filled at least one prescription for medication identified as high-risk by the National Committee for Quality Assurance. Again, the rates varied greatly depending on geographic region, from 9.8 percent in Rochester, Minn., to 29.1 percent in Monroe, La. Progress in this area is being made, as the percentage of Medicare beneficiaries who filled at least one high-risk medication prescription dropped 43 percent from 2006. But more work is needed to eliminate this dangerous practice.
  • The U.S. Preventive Services Task Force (USPSTF) has recommended against using a blood test called a prostate-specific antigen (PSA) test to screen for prostate cancer. And the American Cancer Society and the American Urological Association recommend against PSA testing in older men, although they recommend that younger men (in their 50s up to 69) consult with their doctor about the pros and cons of the test. Still, almost one in five men ages 75 and older—19.5 percent nationally—underwent PSA screening. Regional discrepancies ranged from 9.9 percent in Casper, Wyo., to 30 percent in Miami, Fla.
  • The USPSTF also has warned that there is evidence of potential harm from false positive results from mammography screening for women 75 and older, and insufficient evidence of benefits for them to undergo the test. Yet, almost one in four women 75 and older—24.2 percent—underwent the screening. Regional variation ranged from 15.3 percent in Miami, Fla., to 37.2 percent in Sun City, Ariz.
  • Preventable hospital readmissions have declined 23 percent, from 5.5 percent of Medicare beneficiaries in 2003 to 4.2 percent in 2012. Again, since these are by definition “preventable” readmissions, we must keep working to lower the rate to as close to zero as possible.

Dartmouth__Infographs-02_300pThe John A. Hartford Foundation is very proud to support the work of the Dartmouth Atlas Project, and our commitment to patient-centered and patient-directed care for all older adults is only strengthened after reading about the large variations in quality of care that currently exist depending on where people live. This report describes both the real and potential care needs that we must address. The discussion we need to have in light of this eye-opening report must center on the kind of care that older adults want, need, and how they want that care delivered.

I would like to thank our grantees, Julie Bynum, MD, MPH, working with Ellen Meara, PhD; Chiang-Hua Chang, PhD; Jared M. Rhoads, and their team at the Dartmouth Institute for Health Policy and Clinical Practice, for their work in creating this important report. They used their experience and expertise to delve into enormous quantities of Medicare records and to apply the lens of what matters most to older adults.

The John A. Hartford Foundation was one of the earliest supporters of Dartmouth’s work looking at regional variation in the 1980s. The resulting Dartmouth Atlas Project underscores that big data can make a big difference in our ability to improve the care of older adults. The Atlas provides a huge service to everyone who does research, makes policy, or cares about the health of older people. It is a great tool that we know our grantees and the field will find helpful.

Download and share Our Parents, Ourselves: Health Care for an Aging Population so that it will be referenced and used by hospitals, community providers, and others in their field to make important and needed changes in the care we deliver to older people in this country.

For more information, including links to the full press release and key data tables, visit our special Our Parents, Ourselves page.