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Geography determines who gets surgery, study finds

Thursday, Nov. 29, 2012 10:24 PM
Last updated Thursday, July 11, 2013 2:10 PM
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Where you live could be a powerful determinant of what kind of elective surgery you get, even within a state or city, said a study released Thursday. The authors of the Dartmouth Atlas Project said that could reflect less patient choice and more physician practice tied to local tradition.

The project used Medicare data from 2010, or in some cases averaged data from 2008-10, to look at rates of elective surgeries in the areas hospitals serve. Even within similar states, such as in the South Atlantic region, which stretches from Maryland and Delaware to Florida on the East Coast, rates of some “preference sensitive” surgeries varied widely for similar conditions, said Dr. David Goodman, a co-author and co-principal investigator of the project.

“It is very much an example of where, at least to date, geography is destiny,” he said. “These places really do have their own distinctive signature of surgical practice.”

A Medicare beneficiary in Savannah, Ga., for instance, is twice as likely to receive surgery for lower back pain as a similar patient in Rockville, Md., Goodman said.

The Augusta hospital region usually ranked on the more conservative side in elective surgeries compared with other regions in the South Atlantic. Augusta was near the bottom in rates of hip replacement and surgery to treat early-stage prostate cancer, for instance, but near the top in balloon angioplasty and similar interventions to treat stable angina, the study found.

Rates of other areas of Georgia varied widely, and across the regions studied there was no discernible pattern that would favor rural over urban, or vice versa. Those geographic differences “are really dwarfed by this more idiosyncratic variation that occurs from the local culture of practice” by physicians, Goodman said.

That concerns the group because it might reflect that patients are delegating the choice to have surgery to the physicians, who are usually trained to take a more aggressive approach, Goodman said. That might not reflect what the patient truly wants or needs, study lead author Shannon Brownlee said.

“Patients often don’t get the treatment that is best for them,” she said, “and that’s one of the main things that drive this unwarranted variation.”

The problem stems from a lack of knowledge about the full extent of risks and benefits from the surgery, sometimes on the physician’s part, too, or the inability to communicate that to patients, Goodman said

The Patient Protection and Affordable Care Act will help disseminate a better model of physician-patient interaction, called Shared Decision Making, that seeks to involve patients and families more in the process and give them clearer information on benefits and risks from the procedures. That could bring the rate of some elective surgeries down, Goodman said.

“In general, for many of these procedures in aggregate, the (patients’) choices are to less aggressive care,” he said. “But what is more important is that individual patients choose the treatment that is right for them or the screening test that is right for them.”

Staff Writer Sandy Hodson contributed to this article.

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Riverman1
83480
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Riverman1 11/30/12 - 10:29 am
3
1
"The Patient Protection and

"The Patient Protection and Affordable Care Act will help disseminate a better model of physician-patient interaction, called Shared Decision Making, that seeks to involve patients and families more in the process and give them clearer information on benefits and risks from the procedures. That could bring the rate of some elective surgeries down, Goodman said."

In other words they want more people to say they don't want surgery to save money.

soapy_725
43676
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soapy_725 11/30/12 - 12:10 pm
0
0
Boy, how the coming gloom is bringing out the stats
Unpublished

all kind of new stats. And Sheriff Strength has educated us to the facts that "stats can mean anything".

Gluten is killing us. High Fructose Corn Syrup is destroying our bowels. The federal government is subsidizing all of the foods that lead to obesity and diabetes. All of McDonald's menu, including salads, are foods the feds want you eat. Corn and corn sugar directives.

soapy_725
43676
Points
soapy_725 11/30/12 - 12:14 pm
1
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Propoganda the like of which the USSR never dreamed
Unpublished

A government media machine that make 1940 Germany look like child's play. At least the USSR had a simple theme. Comrades, the rest of the world is about to attack the USSR and living conditions in the rest of the world are worse that the USSR.

soapy_725
43676
Points
soapy_725 11/30/12 - 12:47 pm
0
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Not money or availablility of medical services?
Unpublished

Nothing to do with regional hospitals that specialize in certain procedures or have certain medical devices? Or have a reputation for high success rates in certain procedures. If it is geography, than we need to relocate some folks who can't get medical care. We could create more entitlement centers. These could be the largest metro areas within the twelve federal districts. Financing would come from all taxpayers within those twelve federal districts regardless of state occupancy. Share the wealth or better yet share the pain.

Geography is also the reason public housing isn't working. The resident are geographically located in housing they have trashed and need to be moved to new housing.

Geography is the cause of homelessness. Relocate all of the homeless to these same entitlement centers.

No wonder they stopped teaching geography. Is is the rot cause of all of social ills.

dichotomy
32715
Points
dichotomy 11/30/12 - 07:31 pm
1
0
Yeh, it's gonna bring it down

Yeh, it's gonna bring it down alright.....WAY DOWN.

"Shared Decision Making"

You and your doctor will share information and then somebody that doesn't know either of you will make the decision that all you get is a generic pill.

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