Posting date: October 7, 2004

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

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

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

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