Improving Patient Decision-Making in Health Care

Whether Medicare patients undergo elective surgery depends largely on where they live and the clinicians they see, according to a new report from the Dartmouth Atlas Project and the Foundation for Informed Medical Decision Making. Researchers found remarkably wide regional variations in elective surgery for Medicare patients even though they had similar conditions.

The report compares the rates of elective, or “preference-sensitive,” procedures across regions and suggests that differences in clinicians’ personal beliefs and opinions contribute to the variation. It also highlights variations in Minnesota to demonstrate how patients, policymakers and others can use the report to understand where treatments are more aggressive. Medicare patients in St. Cloud, Minn., for example, are half as likely to undergo cardiac bypass surgery than patients in Detroit Lakes, but more than twice as likely to undergo back surgery than patients in Rochester.

To address these variations, the report’s authors advocate for shared decision-making, a process that helps patients better understand and discuss their choices. Shared decision-making helps the patient become a fully informed partner in the choice, and knowledgeable about the risk and benefit trade-offs of each treatment option.

The Dartmouth Atlas Project is principally funded by the Robert Wood Johnson Foundation.