Is Your Local Medical Culture Quicker To Reach For The Scalpel?

Call me provincial, but as soon as I saw this report full of cool maps of variations on elective surgery put out by the Dartmouth Atlas Project and the Foundation for Informed Medical Decision Making, I wondered whether they might do a version for Massachusetts any time soon. Word from the project is that they're considering a version on Massachusetts or New England some time in the next year.

In the meanwhile, I scanned through this report on Medicare patients — which features national data and Minnesota — and Massachusetts was looking fairly restrained with its elective surgeries, with the one exception of the prostate operation mapped above.

Overall, the national variations are astonishing. The report's press release notes:

Researchers found that men over 65 with early-stage prostate cancer who live in San Luis Obispo, Calif., are 12 times more likely to have surgery to remove their prostate than those in Albany, Ga. Medicare patients with heart disease in Elyria, Ohio, were 10 times more likely to have a procedure such as angioplasty or stents than those in Honolulu. And women over 65 living in Victoria, Texas were seven times more likely to undergo mastectomy for early-stage breast cancer than women in Muncie, Ind.

“These striking variations are the by-product of a doctor-centric medical delivery system.

In highlighting the variation from community to community for elective procedures, we hope to shine a light on the fact that patients’ preferences are not always taken into account when medical decisions are made,” said Shannon Brownlee, M.S., lead report author and instructor at the Dartmouth Institute for Health Policy and Clinical Practice.

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; and prostate cancer screening.