The appropriateness of hysterectomy. A comparison of care in seven health plans. Health Maintenance Organization Quality of Care Consortium.
OBJECTIVE
To develop and test a method for comparing the appropriateness of hysterectomy use in different health plans.


METHODS
Retrospective cohort study.


METHODS
Seven managed care organizations.


METHODS
Random sample of all nonemergency, non-oncological 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.


METHODS
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.


CONCLUSIONS
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.
Bernstein
S J
SJ
School of Medicine, University of Michigan, Ann Arbor.
McGlynn
E A
EA
Siu
A L
AL
Roth
C P
CP
Sherwood
M J
MJ
Keesey
J W
JW
Kosecoff
J
J
Hicks
N R
NR
Brook
R H
RH
D000328:Adult; D000368:Aged; D005260:Female; D006279:Health Maintenance Organizations / Q000592:standards* / Q000706:statistics & numerical data; D006300:Health Services Misuse / Q000706:statistics & numerical data*; D006302:Health Services Research / Q000458:organization & administration; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data*; D008875:Middle Aged; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D014481:United States; D014600:Utilization Review / Q000706:statistics & numerical data*