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J Thorac Cardiovasc Surg 2000;120:976-977
© 2000 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Editorial: In health care, geography is destiny

From the Department of Cardiothoracic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH.

Received for publication Aug 18, 2000. Accepted for publication Aug 23, 2000. Address for reprints: William C. Nugent, MD, Department of Cardiothoracic Surgery, Dartmouth-Hitchcock Medical Center, One Medical Center Dr, Lebanon, NH 03756.

In this issue of the Journal (see page 978), Shahian and colleagues conclude that proximity to home and historical referral patterns are the two most important variables influencing where patients have heart surgery. Location and habit appear to determine where most patients seek care.

These conclusions seem surprising in this modern era of consumer empowerment—more so, given that the eight competing programs in the study lie within 15 miles of one another and in a "mature" marketplace characterized by high penetration of managed care.

However, these findings should not surprise us. A person who is experiencing illness needs help from family and friends. Getting and giving this kind of help is easier when the physical location of care is nearby and when the network of relationships among providers . . . [Full Text of this Article]

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