Who Picks the Hospital?

Tuesday, March 27, 2007

"Informing consumers" has become a buzzword in health care as a panoply of government agencies, quality rating firms, employer coalitions and consumer groups have sought to arm patients with information about hospital quality.

Now a national survey of 500 randomly selected Medicare patients by researchers at Dartmouth Medical School has found that nearly one-third of those who underwent major non-emergency surgery reported that their doctor had been the sole decision-maker about which hospital to choose. That number was greater than the 27 percent who said that they or their families had made the decision. The remaining 42 percent said they had decided along with their doctor.

The study, which appears in the March issue of the Archives of Surgery and was funded by the federal Agency for Healthcare Research and Quality, is believed to be the first to analyze the role of patients in making such a decision.

Chad T. Wilson and his colleagues Steven Woloshin and Lisa Schwartz limited the study to patients who had no apparent cognitive problems and who had undergone one of five procedures three years before the study. The operations were for repair of an abdominal aneurysm, replacement of a heart valve and cancers of the bladder, lung or stomach. The average age of the patients was 78, and 90 percent of them were white.

Researchers, who interviewed patients over the telephone, found that men and those in fair to poor health were more likely to have let the doctor alone decide. The same was true of those undergoing aneurysm or valve operations: Doctors were the primary decision-makers in 39 percent of these cases, compared with 26 percent of cancer surgeries. Overall, 289 patients said they had sought information about the available hospitals from sources other than their doctor.

The finding that two-thirds of patients had been involved in making a decision helps "validate a key assumption" behind the push to make performance data available to consumers, the researchers concluded.

But, they added, the implications of the finding that 31 percent had let the doctor make a potentially life-or-death decision for them is unclear. It is possible that patients wanted to be involved but were stymied "either because a paternalistic physician (or health-care system) imposed a decision on them" or because they couldn't obtain the information they needed.

-- Sandra G. Boodman

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