THE APPROPRIATENESS OF HYSTERECTOMY - A COMPARISON OF CARE IN 7 HEALTH PLANS
THE APPROPRIATENESS OF HYSTERECTOMY - A COMPARISON OF CARE IN 7 HEALTH PLANS
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DOI：
10.1001/jama.269.18.2398
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发表时间：
1993-05-12
影响因子：
120.7
通讯作者：
BROOK, RH
中科院分区：
文献类型：
--
作者：
BERNSTEIN, SJ;MCGLYNN, EA;BROOK, RH
目的：开发和测试一种比较子宫切除术在不同健康计划中使用的适当性的方法。设计。-回溯性队列研究。设置。-七个管理的护理机构。患者。-在七个管理的护理机构中进行的所有非急诊、非肿瘤性子宫切除术的随机样本，为期一年。在子宫切除前2年内没有连续参加计划的患者被排除在外。主要结果衡量标准。-根据管理保健医生小组得出的评级，在每个计划中因不适当的临床原因接受子宫切除的妇女比例。结果：总体而言，大约16%的妇女因被判定为临床不适当的原因而接受子宫切除。只有一个计划的子宫切除手术被评为不合适的比例明显高于该组平均水平(27%，未调整)。调整年龄和种族不影响计划的排名，对数字结果几乎没有影响。结论：不适当使用子宫切除术的比率与其他手术相似，但在健康计划中略有不同。当购买者考虑为他们的员工提供哪些健康计划时，这些信息可能会很有用。
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.