Health Affairs

Posting date: October 7, 2004

This Article Reprint (PDF) Table of Contents Supplemental Exhibit HTML Version Submit a response to this article Alert me when this article is cited Alert me when Comments are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Archive Download to Citation Manager Reprints & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Weinstein, J. N. Articles by Wennberg, J. E. Search for Related Content PubMed PubMed Citation Articles by Weinstein, J. N. Articles by Wennberg, J. E. Related Collections Hospitals Medicare Physicians Chronic Care Quality Of Care State/Local Issues Consumer Issues Variations

Health Affairs, 10.1377/hlthaff.var.81
Copyright © 2004 by Project HOPE

Web Exclusives

Trends: Trends And Geographic Variations In Major Surgery For Degenerative Diseases Of The Hip, Knee, And Spine

James N. Weinstein ^1*, Kristen K. Bronner ², Tamara Shawver Morgan ³, John E. Wennberg ⁴

¹ James Weinstein is professor and chairman of the Department of Orthopaedic Surgery, Dartmouth Medical School, Dartmouth-Hitchcock Medical Center, in Lebanon, New Hampshire.
² Kristen Bronner is a research associate at the Center for the Evaluative Clinical Sciences, Dartmouth Medical School.
³ Tamara Morgan is a research associate in the Department of Orthopaedic Surgery, Dartmouth Medical School.
⁴ John Wennberg is director of the Center for the Evaluative Clinical Sciences and the Peggy Y. Thomson Professor for Evaluative Clinical Sciences, Dartmouth Medical School.

^*Corresponding author.

Abstract

Although Medicare rates for surgery to treat degenerative diseases of the hip, knee, and spine are highly variable among hospital referral regions (HRRs), the relative risk for surgery within a region is constant from year to year--a large majority of the variation in surgery in 2000-01 is "explained" by the variation in rates in 1992-93. The within-region constancy in rates for highly variable procedures (the "surgical signature") is illustrated for South Florida HRRs. Involving the patient in choice of treatments (shared decision making) and outcomes research are promising strategies for reducing unwarranted regional variation and local constancy in surgery risk.

Key Words: Chronic Care, Consumer Issues, Hospitals, Medicare, Physicians, Quality Of Care, State/Local Issues, Variations

                      What's this?

This article has been cited by other articles:

				J. N. Weinstein, T. D. Tosteson, J. D. Lurie, A. N. A. Tosteson, B. Hanscom, J. S. Skinner, W. A. Abdu, A. S. Hilibrand, S. D. Boden, and R. A. Deyo Surgical vs Nonoperative Treatment for Lumbar Disk Herniation: The Spine Patient Outcomes Research Trial (SPORT): A Randomized Trial JAMA, November 22, 2006; 296(20): 2441 - 2450. [Abstract] [Full Text] [PDF]