Geographic Variation in Healthcare Delivery
Geographic variation in healthcare delivery has been documented for decades, revealing significant differences in how care is provided across regions, states, and communities. Understanding these patterns is important for quality professionals who work at the population level or within health systems that span multiple geographic areas.
The Dartmouth Atlas
The Dartmouth Atlas of Health Care is the most well-known resource for studying geographic variation. Using Medicare claims data, the Dartmouth Atlas documents differences in healthcare spending, utilization, and outcomes across hospital referral regions. Key findings include wide variation in rates of surgical procedures, hospitalization for chronic conditions, and end-of-life care intensity. Importantly, regions that spend more do not consistently achieve better outcomes, challenging the assumption that more care equals better care.
Categories of Care Variation
The Dartmouth Atlas framework categorizes care into three types. Effective care includes evidence-based services that all eligible patients should receive (such as vaccinations and beta-blockers after heart attack); variation here represents underuse. Preference-sensitive care includes treatments where multiple options exist and the choice should depend on patient values and preferences (such as prostatectomy versus watchful waiting); variation reflects differences in shared decision-making. Supply-sensitive care includes services whose frequency is influenced by the availability of resources (such as physician visits and hospital days); variation often correlates with bed supply and physician density.
Implications for Quality Improvement
Geographic variation data can help quality professionals identify areas of overuse and underuse within their service areas. Comparing your organization's utilization patterns to regional and national benchmarks reveals opportunities for improvement. Understanding supply-sensitive variation helps leaders make more informed decisions about capacity planning and resource allocation.
Addressing Geographic Variation
Strategies for addressing unwarranted geographic variation include implementing evidence-based care protocols, promoting shared decision-making for preference-sensitive conditions, and using population health management approaches to reduce supply-sensitive utilization. Quality professionals can advocate for data transparency and regional collaboration to align care delivery with evidence-based standards.