Racial variation in treatment preferences and willingness to randomize in the Spine Patient Outcomes Research Trial (SPORT).

Study Design: Analysis of baseline data for patients enrolled in Spine Patient Outcomes Research Trial (SPORT), a project conducting three randomized and three observational cohort studies of surgical and nonoperative treatments for intervertebral disc herniation (IDH), spinal stenosis (SpS), and degenerative spondylolisthesis (DS).

Objective: To explore racial variation in treatment preferences and willingness to be randomized.

Summary Of Background Data: Increasing minority participation in research has been a priority at the NIH.

Trends and geographic variations in major surgery for degenerative diseases of the hip, knee, and spine.

Although Medicare rates for surgery to treat degenerative diseases of the hip, knee, and spine are highly variable among hospital referral regions (HRRs), the relative risk for surgery within a region is constant from year to year-a large majority of the variation in surgery in 2000--01 is "explained" by the variation in rates in 1992--93. The within-region constancy in rates for highly variable procedures (the "surgical signature") is illustrated for South Florida HRRs. Involving the patient in choice of treatments (shared decision making) and outcomes research are promising strategies for reducing unwarranted regional variation and local constancy in surgery risk.