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Dartmouth Atlas Finds Vast Regional Differences in Medicare-Backed Elective Surgery Rates

John Commins, for HealthLeaders Media, February 24, 2011

The report is the first in a series looking at individual states and regions, and highlights Minnesota in addition to presenting national trends. Researchers analyzed the rates of elective or ?preference-sensitive? procedures, including:

  • mastectomy for breast cancer;
  • coronary artery bypass surgery;
  • percutaneous coronary intervention;
  • back surgery;
  • knee and hip joint replacement;
  • carotid artery surgery;
  • gall bladder removal;
  • radical prostatectomy for prostate cancer;

The report also advocates for shared decision-making to help patients understand their choices and share treatment decisions with their clinicians. The report also describes the treatment choices available for the preference-sensitive procedures, all of which can?but do not have to be? treated with surgery, as well as steps patients can take to make sure they get the care they want and need.

?All too often, patients facing elective surgery are not given an opportunity to learn about the full range of options, and that each choice has unique risks and benefits. Many are not even aware that the decision about an elective procedure is actually a choice. Instead, they routinely delegate such important decisions to their clinicians, with the result being that patients often do not get the treatment they would prefer,? says David C. Goodman, MD, report co-author and co-principal investigator for the Dartmouth Atlas Project, and director of the Center for Health Policy Research at the Dartmouth Institute for Health Policy and Clinical Practice.

The researchers explain that differences in clinicians? personal beliefs and opinions contribute to the variation in surgical rates in observed geographic locations. For example, there is considerable disagreement among surgeons about the need for back surgery, its effectiveness, and even the best way to diagnose the cause of back pain. With no consensus about how to diagnose and treat back pain, the rate of back surgery varies widely from place to place.

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1 comments on "Elective Surgery Rates Vary Greatly by Region"


Stefani (2/27/2011 at 5:56 PM)
This is not new news! Jack Wennberg MD began his work by demonstrating that VT children underwent tonsillectomies in the 1970s based on where they lived and the training of the local surgeons....not because of need. Nothing has changed has it?