Improving Patient Decision-Making: Pacific States

In this Dartmouth Atlas report, the last in a series of nine U.S. regional reports, we show the wide regional variation in the likelihood that patients with similar conditions receive elective procedures. This report highlights the Pacific states (Alaska, California, Hawaii, Oregon, and Washington) and shows the variation across the region and the United States.

For patients whose conditions can be treated with elective surgery, location matters. For example, if you have heart disease and live in Eugene, Oregon, you are half as likely to undergo balloon angioplasty than if you live in Fresno, California, and three times as likely to undergo back surgery than if you live in Santa Rosa, California. If you have osteoarthritis of the knee and live in Wenatchee, Washington, you are three times more likely to have your knee replaced than if you live in Honolulu.

This report, a collaborative project with the Informed Medical Decisions Foundation, looks at the variation in surgical rates in 306 hospital referral regions across the United States (a hospital referral region is a large health care market containing at least one referral hospital).

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Carotid endarterectomy rates in Honolulu, Hawaii, 0.4 per thousand. In Modesto, Calif., 3.3.