Calif. Surgery Rates Influenced by Lack of Shared Decision-Making
A project in California found that variation in surgery rates across the state likely stems from miscommunication between doctors and a lack of shared decision-making between physicians and patients, Stateline reports.
The project was launched after a 2011 report by the California HealthCare Foundation found that several surgeries were being performed much more often in Humboldt County than in other areas of the state. CHCF publishes California Healthline.
CHCF has since updated its report to include several additional procedures.
Details of Project
The Humboldt County Surgical Rate Project was launched to identify the reasons for variation in surgery rates and determine how to address the issue, according to Betsy Stapleton, co-director of the initiative.
The project -- which initially was funded by $96,000 from CHCF and the Robert Wood Johnson Foundation -- included:
- Community groups;
- Education institutions;
- Health care advocates; and
The project identified two main reasons for the variation in surgical rates:
- A lack of shared decision-making between physicians and patients; and
- Miscommunications between primary care physicians and surgeons.
Stapleton said, "[A]ll primary care [physicians] and surgeons said they did shared decision-making, but it was clear none of them really knew what that was and neither did patients."
She said providers often presented their own recommendations to patients without outlining all of the options for treatment. Providers' recommendations often can vary based on their education, friendships with other doctors and other factors, according to Stateline.
Meanwhile, Stapleton said primary care doctors often referred patients to surgeons, believing that they could better explain surgical options. However, she said that "surgeons generally took a referral as a request for surgery and they felt they would be disappointing their referral base if they didn't do surgery."
The project calls for:
- Developing a system for doctors to provide information on up-to-date treatment protocols; and
- Improving communications between primary care doctors and surgeons.
Maribeth Shannon, director of CHCF's Market and Policy Monitor Program, said, "If patients are given the choice, you should see less variation in the surgical rates. You should see more movement toward the mean."
The project has received an additional $105,000 from CHCF to create a shared decision-making education program (Ollove, Stateline, 9/23).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.