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The Appropriateness of HysterectomyA Comparison of Care in Seven Health Plans
Steven J. Bernstein, MD, MPH;
Elizabeth A. McGlynn, PhD;
Albert L. Siu, MD, MSPH;
Carol P. Roth, RN, MPH;
Marjorie J. Sherwood, MD;
Joan W. Keesey;
Jacqueline Kosecoff, PhD;
Nicholas R. Hicks, MRCP (UK), MFPHM;
Robert H. Brook, MD, ScD;
the Health Maintenance Organization Quality of Care Consortium;
Jerome Beloff, MD;
Bernard Mansheim, MD;
Norbert Goldfield, MD;
Francis Lieb, MD;
David Ferriss, MD;
Bruce Perry, MD;
Gerald Plotkin, MD;
Jennifer Leaning, MD;
Edward Marine, MD;
Kathleen Curtin, MBA;
John Austin, MD;
Andrew Wiesenthal, MD;
Terry Carr, RN;
Samuel Sapin, MD;
Iris Johnson, RN;
Gloria Swanson, RN;
Sheila Leatherman, MSW
JAMA. 1993;269(18):2398-2402.
Abstract
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Objective.
—To develop and test a method for comparing the appropriateness of hysterectomy use in different health plans.
Design.
—Retrospective cohort study.
Setting.
—Seven managed care organizations.
Patients.
—Random sample of all nonemergency, nononcological hysterectomies performed in the seven managed care organizations over a 1-year period. Patients who were not continuously enrolled in a plan for 2 years prior to their hysterectomy were excluded.
Main Outcome Measures.
—Proportion of women undergoing hysterectomy in each plan for inappropriate clinical reasons according to ratings derived from a panel of managed care physicians.
Results.
—Overall, about 16% of women underwent hysterectomy for reasons judged to be clinically inappropriate. Only one plan had significantly more hysterectomies rated inappropriate compared with the group mean (27%, unadjusted). Adjusting for age and race did not affect the rankings of the plans and had little effect on the numeric results.
Conclusion.
—The rates of inappropriate use of hysterectomies are similar to those for other procedures and vary to a small degree among health plans. This information may be useful to purchasers when they consider which health plans to offer their employees.
(JAMA. 1993;269:2398-2402)
Author Affiliations
AV-MED, Gainesville, Fla; CIGNA Health-plans, Bloomfield, Conn; Group Health Cooperative of Puget Sound, Seattle, Wash; Harvard Community Health Plan, Brookline, Mass; The Health Care Plan of Buffalo (NY); The Health Plan of America, Orange, Calif; Kaiser Permanente, Colorado Region, Denver; Kaiser Permanente, Northwest Region, Portland, Ore; Kaiser Permanente, Southern California Region, Pasadena, Calif; MedCenters Health Plan, Minneapolis, Minn; United HealthCare Corporation, Minneapolis, Minn
From RAND, Santa Monica, Calif (Drs Bernstein, McGlynn, Siu, and Brook, and Ms Keesey); the Schools of Medicine and Public Health, University of Michigan, Ann Arbor (Dr Bernstein); the Schools of Medicine (Drs Siu, Kosecoff, and Brook) and Public Health (Dr Brook), UCLA, Los Angeles, Calif; Value Health Sciences, Santa Monica, Calif (Ms Roth and Drs Sherwood and Kosecoff); and the Department of Public Health Medicine, Oxfordshire Health Authority, Oxford, England (Dr Hicks).
Footnotes
A complete list of the members of the Health Maintenance Organization Quality of Care Consortium appears at the end of this article.
Reprint requests to RAND, 1700 Main St, Santa Monica, CA 90407-2138 (Dr McGlynn).
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