The appropriateness of hysterectomy. A comparison of care in seven health plans. Health Maintenance Organization Quality of Care Consortium

JAMA. 1993 May 12;269(18):2398-402. doi: 10.1001/jama.269.18.2398.


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, 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.

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.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Aged
  • Female
  • Health Maintenance Organizations / standards*
  • Health Maintenance Organizations / statistics & numerical data
  • Health Services Misuse / statistics & numerical data*
  • Health Services Research / organization & administration
  • Humans
  • Hysterectomy / statistics & numerical data*
  • Middle Aged
  • Quality Assurance, Health Care
  • Retrospective Studies
  • United States
  • Utilization Review / statistics & numerical data*