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An Assessment of Prostatectomy for Benign Urinary Tract ObstructionGeographic Variations and the Evaluation of Medical Care Outcomes
John E. Wennberg, MD;
Albert G. Mulley, Jr, MD, MPP;
Daniel Hanley, MD;
Robert P. Timothy, MD;
Floyd J. Fowler, Jr, PhD;
Noralou P. Roos, PhD;
Michael J. Barry, MD;
Klim McPherson, PhD;
E. Robert Greenberg, MD;
David Soule;
Thomas Bubolz, PhD;
Elliott Fisher, MD;
David Malenka, MD
JAMA. 1988;259(20):3027-3030.
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IN MAINE, the efforts of practicing urologists to understand how their clinical decisions contribute to the striking variations in rates of prostatectomy from one community to another led to a critical evaluation of the theories under
See also pp 3010 and 3018. lying the decision to operate. Specific aspects of our work have been described elsewhere.1-3 The purpose of this report is to provide an overview of the prostatectomy assessment project—its background and relevance, the methods used, the principal findings and recommendations—and to comment on the applicability of the approach to the evaluation of other common medical practices.
BACKGROUND
The project was an initiative of the Maine Medical Assessment Program,4,5 an ongoing program sponsored by the Maine Medical Association to respond to the small-area variations in medical practice patterns seen among Maine communities. Striking geographic variations in use are characteristic of many operations, diagnostic procedures, and causes of
. . . [Full Text PDF of this Article]
Author Affiliations
From the Department of Community and Family Medicine, Dartmouth Medical School, Hanover, NH (Drs Wennberg, Greenberg, Bubolz, Fisher, and Malenka); the General Internal Medicine Unit, Massachusetts General Hospital, and Harvard Medical School, Boston (Drs Mulley and Barry); the Maine Medical Assessment Program, Augusta, Me (Drs Hanley and Timothy and Mr Soule); The Center for Survey Research, University of Massachusetts, Boston (Dr Fowler); the Departments of Social and Preventive Medicine and Business Administration, University of Manitoba, Canada (Dr Roos); and the Department of Community Medicine and General Practice, University of Oxford, England (Dr McPherson).
Footnotes
Reprint requests to the Department of Community and Family Medicine, Dartmouth Medical School, Hanover, NH 03756 (Dr Wennberg).
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