THE APPROPRIATENESS OF HYSTERECTOMY - A COMPARISON OF CARE IN 7 HEALTH PLANS

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.