updated 6/5/2008 9:55:10 AM ET 2008-06-05T13:55:10

In Memphis, black Medicare beneficiaries are nearly six times as likely as whites to have a leg amputated, a complication stemming from vascular disease and diabetes.

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In Mississippi, 57 percent of women aged 65-69 got mammograms in a two-year period versus 74 percent in Maine.

And, in Alaska, 71 percent of Medicare patients with diabetes got an important annual test for blood sugar compared with 91 percent in Vermont.

Reducing such racial and regional disparities, detailed by researchers at Dartmouth Medical School, will be a major focus of a $300 million initiative to be announced Thursday by the Robert Wood Johnson Foundation. The program, targeting 14 communities and regions around the country, seeks to improve the quality of health care and to eventually provide models for national health reform.

Dartmouth researchers say that one goal of the project is to cut down on hospital admissions for certain medical conditions. Discretionary stays in the hospital pose a risk to patients and a substantial cost to society.

States with particularly high rates of hospitalization for conditions such as poorly controlled diabetes or worsening heart failure include West Virginia, Kentucky, Louisiana and Mississippi. All had rates of more than 100 discharges per 1,000 Medicare beneficiaries. States with particularly low rates included Washington, Utah and Hawaii.

The United States spends more than $2 trillion annually on health care. While overall life expectancy has improved, many patients fail to get the most appropriate treatment. Some get too much care. Others get too little.

“Despite having the most expensive health care system in the world, patients are subject to too many mistakes, too much miscommunication and too much inequity,” said Dr. Risa Lavizzo-Mourey, president and CEO of the foundation.

She said the money would allow communities to bring together doctors, employers, patients and others to determine which chronic illnesses would be targeted. The foundation will provide resources and technical expertise. Doctors will learn about changes they can make to improve care. Patients will learn how to better manage their conditions, said Lavizzo-Mourey.

Cities participating in the grant program are Cincinnati, Cleveland, Detroit, Memphis, Seattle and Kansas City, Mo. Three states are also participants: Maine, Minnesota and Wisconsin. Regions getting grant money include Humboldt County, Calif., South Central Pennsylvania, Western Michigan, Western New York and Willamette Valley, Ore.

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