title: Dealing with geographic variations in the use of hospitals. The experience of the Maine Medical Assessment Foundation Orthopaedic Study Group.
abstract: Orthopaedists and other physicians in Maine organized the Maine Medical Assessment Foundation to deal with the problem of variations in the rates of hospitalization for orthopaedic conditions. Five musculoskeletal injuries and five orthopaedic procedures were selected for study. The variation in decision-making by orthopaedists was least for fractures of the ankle and fractures of the hip and was greatest for fractures of the forearm, derangement of the knee, and lumbosacral sprain. The rates in an area tended to be consistently high or low for the same treatments. The major reasons for the variations appeared to be related to lack of agreement about optimum treatment. Feedback of data to physicians on variations in patterns of practice reduced the variations.
authors.affiliation: Maine Medical Assessment Foundation, Manchester.
authors.forename: R B
authors.initials: RB
authors.lastname: Keller
authors.forename: D N
authors.initials: DN
authors.lastname: Soule
authors.forename: J E
authors.initials: JE
authors.lastname: Wennberg
authors.forename: D F
authors.initials: DF
authors.lastname: Hanley
mesh_terms: D016512:Ankle Injuries; D000843:Ankle Joint / Q000601:surgery; D005543:Forearm Injuries / Q000601:surgery; D050723:Fractures, Bone / Q000601:surgery; D025981:Hip Injuries; D006621:Hip Joint / Q000601:surgery; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007403:Intervertebral Disc / Q000601:surgery; D007595:Joint Prosthesis; D007718:Knee Injuries / Q000601:surgery; D008159:Lumbar Vertebrae / Q000293:injuries / Q000601:surgery; D008281:Maine; D009985:Orthopedics / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012447:Sacrum / Q000293:injuries / Q000601:surgery; D013180:Sprains and Strains / Q000601:surgery