Appropriateness of Hysterectomy as Treatment for Benign Gynecological Conditions.
Objective: To assess the appropriateness of hysterectomies performed at a large tertiary health system using the 1997 RAND appropriateness classification system and an updated algorithm. Design: We abstracted structured and unstructured data from electronic medical records on patient demographics, p...
| Publicado en: | Journal of Women's Health (15409996) Vol. 33; no. 10; pp. 1358 - 1367 |
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| Autores principales: | , , , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Mary Ann Liebert, Inc.
Oct2024
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=180216321&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 180216321 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 15409996 Q13 jtl: Journal of Women's Health (15409996) issn: 15409996 maglogo: N pubinfo: dt: Oct2024 vid: 33 iid: 10 pid: 1365 pub: Mary Ann Liebert, Inc. place: New Rochelle, New York artinfo: ui: 180216321 180216321 180216321 10.1089/jwh.2024.0142 180216321 ppf: 1358 ppct: 9 formats: tig: atl: Appropriateness of Hysterectomy as Treatment for Benign Gynecological Conditions. aug: au: Wright, Maya A. Kinlaw, Alan C. McClurg, Asha B. Carey, Erin Doll, Kemi M. Vines, Anissa I. Olshan, Andrew F. Robinson, Whitney R. affil: Tanaq Support Services LLC, Atlanta, Georgia, USA. sug: subj: Hysterectomy Classification Tertiary Health Care Algorithms Genital Diseases, Female Surgery Treatment Outcomes Human Electronic Health Records Coding Adolescence Adult Female Health Information Descriptive Statistics Uncertainty Gender Affirming Care Laparoscopy Sensitivity and Specificity Funding Source Adolescent: 13-18 years Adult: 19-44 years Female ab: Objective: To assess the appropriateness of hysterectomies performed at a large tertiary health system using the 1997 RAND appropriateness classification system and an updated algorithm. Design: We abstracted structured and unstructured data from electronic medical records on patient demographics, primary indication(s) for hysterectomy, diagnosis codes associated with the hysterectomy, previous treatments, and laboratory results. Subjects: Patients aged 18–44 years. Exposure: Receipt of hysterectomy for benign and nonobstetric conditions from October 2014 to December 2017. Main Outcome Measures: Using these data, we provided a RAND-based (dichotomous: inappropriate/appropriate) and Wright-based (3-level: inappropriate/ambiguous/appropriate) appropriateness rating and characterized missing information patterns associated with inappropriate ratings. Results: We analyzed 1,829 hysterectomies across 30 nonmutually exclusive primary indications for surgery. Nearly a third (32.8%) of surgeries had only one primary indication for surgery. Using the RAND-based classifier, 31.3% of hysterectomies were rated as appropriate and 68.7% as inappropriate. Using the Wright-based algorithm, 58.1% of hysterectomies were rated as appropriate, 15.7% as ambiguous, and 26.2% as inappropriate. Missing information on diagnostic procedures was the most common characteristic related to both RAND-based (46.1%) and Wright-based (51.2%) inappropriate ratings. Conclusions: The 1997 RAND classification lacked guidance for several contemporary indications, including gender-affirming care. RAND also has an outdated requirement for diagnostic surgeries such as laparoscopies, which have decreased in practice as diagnostic imaging has improved. Sensitivity analyses suggest that inappropriate surgeries cannot all be attributed to bias from missing electronic medical record data. Accurately documenting care delivery for benign gynecological conditions is key to ensuring quality and equity in gynecological care. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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