It’s Not About The Box Improving Care at Group Health with People, Process and Technology

September 23, 2011

Shared Decision Making in DC

Filed under: Shared Decision Making — Matt Handley @ 4:59 am

I am at a shared decision making conference in DC  – day 2

Shannon Brownlee, great writer and speaker and author of “Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer” – is leading off the day.  A compelling writer, she started with a story.  A patient with panic attacks that eventually ends up with an angiogram to “just be sure”, despite a very low pretest probability, and after her angiogram looks fine she has a serious complication that leads to cardiac arrest and now serious long term health problems.  A high price to pay for reassurance.  The combination of a passive patient, physicians who did not listen to her whole story, and an over-reliance on technology.

OK – so everyone in the room is hooked

She shared a report that I was not aware of – The California Healthcare Foundations analysis of variation in procedure rates across California.  Important work that extends the idea of the Dartmouth Atlas (which uses Medicare data) to younger populations.  No surprise that there is dramatic variation across the state in most everything.  The researchers have also adjusted for income, race/ethnicity, and CVD risk (using MI and DM as proxies).  There is a great interactive map that you should check out.

This is really an effort to inform three audiences – policy makers/payors, doctors and patients.  We will have to invest in all three groups to work to diminish the variation and have it be driven mostly by clinical circumstances and patient preference


  1. Thanks, Matt. The interactive map is amazing. How’s this tibit?

    “Women who live in the Berkeley region deliver vaginally after having had a cesarean section at 301% of the state average rate. “

    Comment by A T Abbott — September 23, 2011 @ 8:24 am

  2. You think that is bad – check out Clear Lake and PCI – 538% rate. Seems like the famous Redding CA cardiovascular group moved a few miles south….

    Comment by Matt Handley — September 23, 2011 @ 8:28 am

  3. I’d be curious to know the cultural makeup of the areas where elective c-sections are highest. If the concentration of the Hispanic/Latino community is what I think it is, then it is actually a very “normal” thing in Mexico for a c-section to be done versus a vaginal delivery. Perhaps with more focused education that recognizes cultural barriers, these numbers could decrease?

    Comment by Kim Nichols — September 29, 2011 @ 1:48 pm

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