{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T11:52:00Z","timestamp":1782301920004,"version":"3.54.5"},"reference-count":28,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T00:00:00Z","timestamp":1756684800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T00:00:00Z","timestamp":1756684800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100008299","name":"Dartmouth College","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008299","id-type":"DOI","asserted-by":"publisher"}]},{"name":"John E. Wennberg Distinguished Professorship in Health Policy and Clinical Practice"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["INQUIRY"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:p>The Dartmouth Atlas of Health Care published data on regional variations in healthcare for Medicare fee-for-service beneficiaries from 1996 to 2022. Despite its revolutionary impact on health services research and policymaking, to our knowledge, no comprehensive review has been undertaken to systematically study how the Dartmouth Atlas has been used by the research community. We identified all 8507 publications that cited the Dartmouth Atlas between 1996 and 2023. With this corpus, we conducted authorship network analyses and conducted a content analysis of a 5% random sample (n\u2009=\u2009403). Network analyses showed a high degree of co-author clustering and little cross-community co-authorship. Content analysis showed that most publications had no author affiliation with Dartmouth (88%, 95% CI\u2009=\u20090.85-0.91), were quantitative observational studies (51%, 95% CI\u2009=\u20090.47-0.57), and cited the Dartmouth Atlas without using its data (71%, 95% CI\u2009=\u20090.67-0.76). Among the 29% publications (n\u2009=\u2009116) that directly used Dartmouth Atlas data, most (76%, 95% CI\u2009=\u20090.67-0.83) used the crosswalk tool to define geographic units, and many (45%, 95% CI\u2009=\u20090.36-0.54) used the data as variables in hypothesis testing. Most studies did not acknowledge the data limitations of the Dartmouth Atlas when using its data, though more acknowledged similar limitations for their overall study design that also involved Medicare fee-for-service data. Our results demonstrated the wide impact of the Dartmouth Atlas and suggested potential opportunities for improving data users\u2019 understanding of the critical assumptions in producing the Dartmouth Atlas data.<\/jats:p>","DOI":"10.1177\/00469580251382062","type":"journal-article","created":{"date-parts":[[2025,10,18]],"date-time":"2025-10-18T15:58:57Z","timestamp":1760803137000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Health Services Researchers\u2019 Use of the Dartmouth Atlas of Health Care: A Literature Review and Network Analysis 1996-2023"],"prefix":"10.1177","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4238-9723","authenticated-orcid":false,"given":"Jingyi","family":"Zhang","sequence":"first","affiliation":[{"name":"The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleni","family":"Fanouraki","sequence":"additional","affiliation":[{"name":"The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uma","family":"Alagappan","sequence":"additional","affiliation":[{"name":"The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carleigh","family":"Drill","sequence":"additional","affiliation":[{"name":"The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pulkit","family":"Nagpal","sequence":"additional","affiliation":[{"name":"The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carly","family":"Bobak","sequence":"additional","affiliation":[{"name":"Research Computing and Data Services, Information, Technology &amp; Consulting, Dartmouth College, Lebanon, NH, USA"},{"name":"Biomedical Data Science, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sai","family":"Lakkireddy","sequence":"additional","affiliation":[{"name":"Program in Quantitative Biomedical Sciences, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8415-3770","authenticated-orcid":false,"given":"Jacqueline D.","family":"Wernimont","sequence":"additional","affiliation":[{"name":"Digital Humanities and Social Engagement, College of Arts and Sciences, Dartmouth College, Hanover, NH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1080-6270","authenticated-orcid":false,"given":"Amber E.","family":"Barnato","sequence":"additional","affiliation":[{"name":"The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA"},{"name":"Section of Palliative Care, Department of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,10,18]]},"reference":[{"key":"e_1_3_3_2_2","unstructured":"Dartmouth Atlas of Health Care. About. April 25 2018. Accessed March 22 2024. https:\/\/www.dartmouthatlas.org\/about\/"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1126\/science.182.4117.1102"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1007\/s43999-022-00006-2"},{"key":"e_1_3_3_5_2","volume-title":"An Agenda for Change: Improving Quality and Curbing Health Care Spending: Opportunities for the Congress and the Obama Administration","author":"Wennberg JE","year":"2008","unstructured":"Wennberg JE, Brownlee S, Fisher ES, Skinner JS, Weinstein JN. An Agenda for Change: Improving Quality and Curbing Health Care Spending: Opportunities for the Congress and the Obama Administration. The Dartmouth Institute for Health Policy and Clinical Practice; 2008."},{"key":"e_1_3_3_6_2","unstructured":"Dartmouth Atlas of Health Care. FAQ - Dartmouth Atlas of Health Care. July 11 2018. Accessed March 22 2024. https:\/\/www.dartmouthatlas.org\/faq\/"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.292.22.2765"},{"key":"e_1_3_3_8_2","unstructured":"Skinner J Fisher E. Dartmouth researchers respond to the times. The New York Times. March 29 2010. Accessed July 4 2025. https:\/\/www.nytimes.com\/interactive\/projects\/documents\/documents-related-to-the-dartmouth-atlas#document"},{"key":"e_1_3_3_9_2","unstructured":"Dean T. Building on the Legacy of the Dartmouth Atlas of Healthcare to Advance Health Equity: Q & A with Dr. Amber Barnato. Geisel News. June 1 2023. Accessed September 2 2024. https:\/\/geiselmed.dartmouth.edu\/news\/2023\/building-on-the-legacy-of-the-dartmouth-atlas-of-healthcare-to-advance-health-equity-q-a-with-dr-amber-barnato\/"},{"key":"e_1_3_3_10_2","unstructured":"Barnato A. Q&A with Amber Barnato: a new Dartmouth Atlas for a more equitable world. 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