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Trends and Regional Variation in Carotid Revascularization
This report discusses recent trends and regional variation in the treatment of cerebrovascular atherosclerosis, a disease in which plaque accumulates to cause a blockage of the carotid artery. In its most advanced stages, this condition may cause a disruption of blood flow to the brain, commonly called a stroke.
Trends and Regional Variation in Carotid Revascularization
This report discusses recent trends and regional variation in the treatment of cerebrovascular atherosclerosis, a disease in which plaque accumulates to cause a blockage of the carotid artery. In its most advanced stages, this condition may cause a disruption of blood flow to the brain, commonly called a stroke.
Variation in the Care of Surgical Conditions
The new Dartmouth Atlas series on variation in the care of surgical conditions, including this report on the treatment of diabetes and peripheral arterial disease, raises new questions regarding surgical management of both common and less frequently occurring medical conditions. This report carefully details the scope of the problem of diabetes and peripheral arterial disease and, as in previous Atlas analyses, emphasizes geographic practice variation in both preventive services and in surgical treatment rates. However, the report also takes a more patient-centered view. The goals of avoiding amputation and retaining the ability to walk are paramount. The best strategies to achieve these goals are the focus of quality improvement groups such as the Vascular Quality Initiative, described in this report. The outcomes data being recorded should go a long way toward producing the kind of widely applicable data upon which patient decision support tools should be based. Patients want to know procedure and facility-based risks and benefits.
Variation in the Care of Surgical Conditions
The new Dartmouth Atlas series on variation in the care of surgical conditions, including this report on the treatment of diabetes and peripheral arterial disease, raises new questions regarding surgical management of both common and less frequently occurring medical conditions. This report carefully details the scope of the problem of diabetes and peripheral arterial disease and, as in previous Atlas analyses, emphasizes geographic practice variation in both preventive services and in surgical treatment rates. However, the report also takes a more patient-centered view. The goals of avoiding amputation and retaining the ability to walk are paramount. The best strategies to achieve these goals are the focus of quality improvement groups such as the Vascular Quality Initiative, described in this report. The outcomes data being recorded should go a long way toward producing the kind of widely applicable data upon which patient decision support tools should be based. Patients want to know procedure and facility-based risks and benefits.
Money
This is the story of John Self, consumer extraordinaire. Ceaselessly inventive and savage, this is a tale of life lived without restraint; of money, the terrible things it can do and the disasters it can precipitate.
Variation in the Care of Surgical Conditions
Despite many years of attention and study, variation in the diagnosis and treatment of prostate cancer persists in the United States. While some progress has been made--for example, screening practices are becoming more risk-based than population-based--new questions have arisen: for example, how best to counsel patients regarding their risk of cancer and the benefits and trade-offs of treatment; how to optimize outcomes related to treatment; and which patients are best treated with active surveillance. While these questions are being answered, clinicians and health systems need to strive to incorporate the best available evidence and shared decision-making into their efforts to detect and treat prostate cancer.
Variation in the Care of Surgical Conditions
Despite many years of attention and study, variation in the diagnosis and treatment of prostate cancer persists in the United States. While some progress has been made--for example, screening practices are becoming more risk-based than population-based--new questions have arisen: for example, how best to counsel patients regarding their risk of cancer and the benefits and trade-offs of treatment; how to optimize outcomes related to treatment; and which patients are best treated with active surveillance. While these questions are being answered, clinicians and health systems need to strive to incorporate the best available evidence and shared decision-making into their efforts to detect and treat prostate cancer.
Variation in the Care of Surgical Conditions
The new Dartmouth Atlas series on variation in the care of surgical conditions, including this report on the surgical treatment of cerebral aneurysms, raises new questions regarding surgical management of both common and less frequently occurring medical conditions. This report carefully details the prevalence of cerebral aneurysms and, as in previous Atlas analyses, emphasizes geographic practice variation in surgical treatment rates. However, the report also takes a more longitudinal view. The changes over time in which procedure is favored to treat aneurysms are particularly fascinating, driven as they appear to be by a mix of clinical evidence--including emerging long-term results--and physicians' opinions and personal experience.
