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

Objective.-To develop and test a method for comparing the appropriaten ess of hysterectomy use in different health plans. Design.-Retrospecti ve cohort study. Setting.-Seven managed care organizations. Patients.- Random sample of all nonemergency, nononcological hysterectomies perfo rmed in the seven managed care organizations over a 1-year period. Pat ients who were not continuously enrolled in a plan for 2 years prior t o their hysterectomy were excluded. Main Outcome Measures.-Proportion of women undergoing hysterectomy in each plan for inappropriate clinic al reasons according to ratings derived from a panel of managed care p hysicians. 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 th e group mean (27%, unadjusted). Adjusting for age and race did not aff ect the rankings of the plans and had little effect on the numeric res ults. Conclusion.-The rates of inappropriate use of hysterectomies are similar to those for other procedures and vary to a small degree amon g health plans. This information may be useful to purchasers when they consider which health plans to offer their employees.