Indications for Hysterectomy: Variation within and Across Hospitals

Arndt, Margarete; Bradbury, R C; Golec, Joseph H.

doi:10.1177/107755879505200302

Cited by 9 publications

(5 citation statements)

References 46 publications

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“…The con®rmation of the second prediction is especially critical: where doctors work in different hospitals with different (procedure-speci®c) lengths of stay, intradoctor variation can be observed, that is to say that doctors choose a length of stay in the direction of the standard of the hospital in which they are working at the time. Arndt, Bradbury, and Golec recently showed that surgeons within medical teams do not vary in their policy on when it is appropriate to perform a hysterectomy, but between teams in different hospitals they observed large variations (23).…”

Section: Orientation Towards Local Standardsmentioning

confidence: 99%

Medical practice variations: changing the theoretical approach

Westert

Groenewegen

1999

Scand J Public Health

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Variations in medical practice are well documented, but there has been less progress in explaining these variations. This paper discusses the existing theories and hypotheses and concludes that a change in theoretical approach is required, to one that more directly highlights the social context influencing the behaviour of doctors in their daily practice. An initial alternative model for explaining variation in practice style is presented. The paper illustrates how (combinations of) important structural factors, such as the availability of hospital resources, the way the doctor is reimbursed, the availability of patients, professional uncertainty, and the way the hospital is financed, lead to hypotheses about when different local standards of medical care emerge. It is concluded that theoretical progress in research on variations in medical practice is possible and that empirical research needs to be driven by hypotheses that emphasize the role of social contexts in the doctor's decision behaviour. Some suggestions for future lines of research are outlined.

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Section: Orientation Towards Local Standardsmentioning

confidence: 99%

Medical practice variations: changing the theoretical approach

Westert

Groenewegen

1999

Scand J Public Health

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“…Hysterectomy has long been a poster child for unexplained area-based variation. For example, rates differ across regions, within states, and between medical facilities 6–15 . Of the small literature on area-level correlates of hysterectomy use in the US, a Los Angeles-based study found higher median family income and percent non-White residential population were positively associated with higher area-level hysterectomy rates 7 .…”

Section: Introductionmentioning

confidence: 99%

Contemporary Geographic Variation and Sociodemographic Correlates of Hysterectomy Rates Among Reproductive-Age Women

Gartner¹,

Doll²,

Hummer³

et al. 2018

Southern Medical Journal

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Objective For decades hysterectomy rates have famously demonstrated unexplained geographic variation. The aim of this study was to identify county-level correlates of hysterectomy rates among reproductive aged women. Methods Using county-level data from multiple sources, linked with claims-based surveillance data of every hysterectomy performed among women ages 18 to 44 in North Carolina from 2011 to 2013 (N=7,180), we explored social, economic, and healthcare factors associated with county-level rates. Results After accounting for spatial autocorrelation, county-level hysterectomy rates were negatively associated with county-level median household income, positively associated with the proportion married, and not associated with measures of healthcare capacity or access. Conclusion This analysis provides preliminary evidence that contemporary hysterectomy use in NC occurs along socioeconomic lines.

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“…A study on variation in length of hospital stay showed that variation within a medical team is small, compared to variation between teams (Westert, 1992). Hence, similarities are patterned by hospitals (Arndt, Bradbury, & Golec, 1995;Westert, Nieboer, & Groenewegen, 1993).…”

Section: Introductionmentioning

confidence: 99%

Mutual influences of general practitioners in partnerships

Jong

Groenewegen

Westert

2003

Social Science & Medicine

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The aim of this study was to find out whether or not general practitioners (GPs) within the same partnership show more similarities in attitudes and behaviour than GPs in different partnerships, and what the causes of these similarities might be. Knowledge of the causes of patterns of similarities within medical teams contributes to understanding medical practice variation, which is crucial in developing effective health care policies.Data were used from the Dutch National Survey of General Practice ('87/'88), consisting of a stratified sample of 161 Dutch GPs, who served 335,000 patients in total.To find out whether GPs in the same partnership are indeed more similar than GPs randomly chosen from different partnerships, we constructed two kinds of pairs: all possible pairs of GPs working in the same partnership (actual pairs), and randomly constructed pairs of GPs who are not working in the same partnership (random pairs). For each pair difference scores were computed for a variety of attitudes and behaviour. Difference scores for actual and random pairs were analysed using multi-level analysis.Most differences in attitudes and behaviour were smaller for actual pairs than for random pairs. Furthermore, in the majority of the cases differences were no longer statistically significant after explanatory variables indicating selection, gradual adaptation and rapid adaptation through shared circumstances were taken into account.It was found that Dutch GPs working in the same partnership showed more resemblance in attitudes and behaviour than GPs not working in the same partnership. Most indications point towards circumstances, and to a lesser extent towards adaptation, as an explanation of similarities within partnerships. The implication of this study is that medical practice variations are not merely individual differences in preferred practice style, but are patterned by social processes in partnerships and local circumstances. r

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Indications for Hysterectomy: Variation within and Across Hospitals

Cited by 9 publications

References 46 publications

Medical practice variations: changing the theoretical approach

Medical practice variations: changing the theoretical approach

Contemporary Geographic Variation and Sociodemographic Correlates of Hysterectomy Rates Among Reproductive-Age Women

Mutual influences of general practitioners in partnerships

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