Lack of communication often leads to big variations in care, higher costs

It's generally accepted that the rates of surgery patients vary across small and large geographical regions across the county. But the reasons for such huge variations are complicated, Stateline reported.

In Northern California, the variations are huge. Males in Tracy, 70 miles east of San Francisco, are nearly five times more likely to undergo internal radiation for prostate cancer than the statewide average. In Clearlake, north of Sacramento, the rate of coronary bypass grafs are more the double the statewide average. But in Deer Park, 45 miles south, the rates are 84 percent of the statewide average.

Those surgical variations lead to higher healthcare costs and can even harm patients--a state of affairs that must change, the American Hospital Association said earlier this year. It also prompted the Humboldt County Surgical Rate Project in Northern California.

"We weren't trying to identify anyone as a 'bad guy,'" Betsy Stapleton, a retired nurse practitioner and co-director of the Humboldt County Surgical Rate Project, told Stateline. "The idea was to identify what was actually happening out there and to figure out ways to address it."

Among the factors the project discovered: Patients don't play a big enough role in their healthcare delivery and the styles of doctors also varied greatly.

"In the case of surgery, different surgeons have different beliefs about the threshold when surgery is warranted," Shannon Brownlee, a senior vice president with the Lown Institute, a think tank concerned with overtreatment in medicine, told Stateline. "When you see variation in the rate of heart surgeries that doesn't track the variation in heart disease you know that it isn't driven by the medical needs of the population but by something else, and that something else is often the preferences of doctors."

Moreover, many physicians do not present the full range of options to their patients. Surgeons, for example, often receive patients referred by primary care doctors, and they felt obligated to recommend surgery over other options. That, paired with the lack of information provided to patients, means patients are more likely to accede to the surgeon's preference.

The Humboldt County Surgical Rate Project also received funding to create a shared decision-making education program for both patients and physicians in the hope of improving communication and cutting down on excess procedures.

To learn more:
- read the Stateline article

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