Interactive Map: Elective Surgery Choices Vary By Location

Rates per 1,000 Medicare beneficiaries of percutaneous coronary intervention procedures (including balloon angioplasty with stents) in hospital service areas in 2008-2010. To see the data on all the measures for a given region, click on the region.

Source: Dartmouth Atlas Project

Where a person lives can determine whether he or she undergoes certain elective surgeries, a recently released report found.

The report by the Dartmouth Atlas Project, which documents variations in how medical resources are distributed and used throughout the nation, contends that when a person has several options for dealing with such issues as early-stage breast cancer, stable angina or low back pain, a person’s location and doctors play a major role in their treatment.

“In health care, to a remarkable degree, geography is destiny,” states the report, “Improving Patient Decision-Making in Health Care.”

It found a “wide regional variation in the likelihood that patients with similar conditions receive elective procedures” across the United States and regionally when it looked at data for Medicare recipients adjusted for age, sex and race differences in large healthcare markets known as hospital referral regions.

The report found, for instance, that a person with heart disease living in the New Brunswick area is twice as likely to undergo a balloon angioplasty as someone with the same condition in York, Pa. That trend holds true among smaller hospital service areas, which typically include only one hospital, within New Jersey.

The rate of percutaneous coronary intervention (PCI) procedures such as angioplasty done between 2008 and 2010 ranged from 5.5 per 1,000 patients in the Livingston area to 15.9 per 1,000 in Newark.

There were also wide differences in knee-replacement surgeries to deal with osteoarthritis, ranging from 2.9 per 1,000 Medicare beneficiaries in Perth Amboy to 10 per 1,000 in Cape May Courthouse.

The greatest variation among larger hospital regions in the Middle Atlantic States was in the use of prostate-specific antigen testing to screen for prostate cancer, according to the report. Within New Jersey, the rate of PSA testing ranged from 24 percent around Phillipsburg to almost 57 percent in Wayne.

One goal of the project is to make patients, their family members and clinicians aware of the variations and help them understand why they occur, including “the fact that patients’ preferences are not always taken into account when medical decisions are made,” according to the report. Instead, treatment “depends more on the physician’s recommendations than the patient’s preferences,” it added.

“All too often, patients facing the possibility of elective surgery are not given an opportunity to understand their options fully,” the report states. “Many patients are not even aware that the decision about elective surgery is actually a choice and that it should generally be theirs to make. Instead, they routinely delegate such important, even life-altering decisions to their clinicians in the belief that ‘the doctor knows best.’ The result is that patients often do not get the treatment that they would prefer.”