Understanding of regional variation in the use of surgery.
The use of common surgical procedures varies widely across regions. Differences in illness burden, diagnostic practices, and patient attitudes about medical intervention explain only a small degree of regional variation in surgery rates. Evidence suggests that surgical variation results mainly from differences in physician beliefs about the indications for surgery, and the extent to which patient preferences are incorporated into treatment decisions. These two components of clinical decision making help to explain the so-called surgical signatures of specific procedures, and why some consistently vary more than others. Variation in clinical decision making is, in turn, affected by broad environmental factors, including technology diffusion, supply of specialists, local training frameworks, financial incentives, and regulatory factors, which vary across countries. Better scientific evidence about the comparative effectiveness of surgical and non-surgical interventions could help to mitigate regional variation, but broader dissemination of shared decision aids will be essential to reduce variation in preference-sensitive disorders.
Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI 48109, USA. jbirkmey@umich.edu
John D
JD
Birkmeyer
Bradley N
BN
Reames
Peter
P
McCulloch
Andrew J
AJ
Carr
W Bruce
WB
Campbell
John E
JE
Wennberg
D001291:Attitude of Health Personnel; D001294:Attitude to Health; D062306:Geography, Medical / Q000706:statistics & numerical data; D006801:Humans; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D010358:Patient Participation / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012111:Residence Characteristics; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data*