The Dartmouth Atlas Project has released the first four of nine regional reports looking at the variation in elective surgery rates for 306 hospital referral regions across the U.S. The report shows that whether Medicare patients undergo elective surgery depends largely on where they live and the providers they see. Authors found that for many conditions, especially those where elective surgery is an option, the treatment a patient receives depends more on the physician’s recommendations than the patient’s preferences.
The Improving Patient Decision-Making in Health Care series, a collaborative project with the Informed Medical Decisions Foundation, highlights significant variations in rates of elective surgery for preference-sensitive conditions, that is, conditions for where there is more than one reasonable option. For example, if you have heart disease and live in York, PA, you are half as likely to undergo balloon angioplasty than if you live in New Brunswick, NJ, and twice as likely to undergo back surgery than if you live in Philadelphia. And if you have osteoarthritis of the knee and live in Calais, Maine, you are twice as likely to have your knee replaced than if you live in Providence, RI.
Previous research shows that patients are often unaware that the decision to have elective surgery is actually a choice and one that they should make, not their provider. Too often, patients do not get the treatment they would prefer because they are not asked about their individual preferences and circumstances.
“Patient preference is especially important when facing a decision about a test or treatment where there is more than one medically reasonable option,” says Dr. Michael J. Barry, president of the Foundation and report co-author. “In order to ensure that patients get the treatment that is right for them, the choice should be a shared decision. When done right, shared decision making results in a better decision: a personalized choice based on both the best scientific evidence and the patient’s values.”