Geographic variation in lumbar diskectomy: a protocol for evaluation.
In 1989 the Maryland Hospital Association (MHA) began developing a protocol related to lumbar diskectomy, a procedure with widely reported geographic variation in its use. The MHA's Laminectomy Advisory Committee drafted three criteria for performance of lumbar diskectomy and also developed a data-collection instrument with which the eight hospitals participating in a pilot study could abstract the necessary data from medical records. Both individual hospital and aggregate results showed wide variation in compliance with the criteria. These findings suggest research and development activities such as refinement of the data-collection instrument, use of the protocol for bench-marking, further investigation of clinical and other determinants of rate variation, and study of the effect of new diagnostic technology on utilization rates for this procedure.
Barron
M
M
Maryland Hospital Education Institute, Lutherville.
Kazandjian
V A
VA
D002391:Catchment Area, Health; D003625:Data Collection / Q000379:methods*; D005260:Female; D005568:Forms and Records Control; D006761:Hospitals; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000000981:diagnostic imaging / Q000601:surgery* / Q000628:therapy; D007796:Laminectomy / Q000592:standards / Q000706:statistics & numerical data*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008396:Maryland; D010818:Practice Patterns, Physicians'; D011785:Quality Assurance, Health Care; D011877:Radionuclide Imaging; D014600:Utilization Review