Alternative Treatment Utilization Before Hysterectomy for Benign Gynecologic Conditions at a Large Integrated Health System

Nguyen, Nancy; Weintraub, Miranda Ritterman; Salyer, Chelsea; Poceta, Joanna; Diaz, Lucero; Zaritsky, Eve

doi:10.1016/j.jmig.2018.08.013

Cited by 10 publications

(11 citation statements)

References 21 publications

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“…3,4 Our findings are in line with prior studies reporting that many hysterectomies performed for benign indications do not adhere to management guidelines. 3,4 We recognize a number of limitations. We cannot exclude the possibility that a small number of conservative interventions were not captured, that some interventions occurred more than 2 years before hysterectomy, and that a relatively large number of patients were excluded due to gaps in insurance coverage.…”

Section: Discussionsupporting

confidence: 89%

“…2 Although treatment selection should be based on shared decision making, many health care professionals recommend a trial of more conservative therapies before hysterectomy. 3,4 These treatments, which can significantly reduce health care costs and improve quality of life, are frequently underused. 3,4 We sought to identify and characterize factors associated with underuse of conservative treatments before hysterectomy for leiomyomas among patients with commercial insurance in the United States.…”

Section: Introductionmentioning

confidence: 99%

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Use of Conservative Therapies Before Hysterectomy for Uterine Leiomyomas

Liao

Chen

Melamed

et al. 2023

Obstetrics &Amp; Gynecology

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We used a claims database to identify patients with uterine leiomyomas who underwent hysterectomy between 2011 and 2019. Use of conservative medical and surgical interventions in the 24-month period before hysterectomy was explored. Overall, 59.7% of patients did not receive any conservative intervention before hysterectomy. Individuals who underwent hysterectomy in more recent years and those with endometriosis, abnormal bleeding, greater comorbidity, or prior venous thromboembolism were more likely to receive conservative interventions.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Use of Conservative Therapies Before Hysterectomy for Uterine Leiomyomas

Liao

Chen

Melamed

et al. 2023

Obstetrics &Amp; Gynecology

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show abstract

“…First-line treatment for uterine fibroids, endometriosis, and other benign diseases increasingly focuses on medical management or surgical removal of abnormal lesions while leaving the uterus and other organs intact to the extent possible. Candidates for hysterectomy for benign conditions often have had a trial of at least one conservative treatment that has failed to adequately resolve pain or other bothersome symptoms (Nguyen et al, 2019).…”

Section: Overview Of Gynecologic Surgerymentioning

confidence: 99%

Gynecologic surgery.

Bradford¹

2023

Psychological Assessment of Surgical Candidates: Evidence-Based Procedures and Practices.

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Benign gynecologic conditions, such as uterine fibroids, endometriosis, and pelvic organ prolapse, are highly prevalent and adversely affect quality of life (Marsh et al., 2018;Nnoaham et al., 2011;Pynnä et al., 2021). Cancers of the female reproductive tract are less common but are likely to have far-reaching effects on health and quality of life. Although nonsurgical treatments are, in some cases, able to reduce or prevent the need for surgery, surgery remains a mainstay in the treatment of both benign and malignant gynecologic conditions. Negative psychosocial outcomes occur in only a small proportion of patients who undergo elective procedures for benign disease. Nevertheless, this minority represents a large number of women, given the large overall number who are treated for gynecologic disease.In addition to the potential physical, social, emotional, and financial toll of surgery, gynecologic procedures are unique in that they specifically target reproductive organs. Surgery for gynecologic disorders may provide relief of pain and other bothersome symptoms, but it is potentially at the expense of other outcomes that reduce quality of life. Removal of reproductive organs may be associated with feelings of loss, especially in younger women and

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“…Thus, there are internal incentives to provide high-value service, as defined by these payment models. This is evidenced by the low hysterectomy rate and the high alternative treatment rate before hysterectomy seen at Kaiser compared with national data [7,8].…”

Section: Quality Metrics In Gynecologic Surgery and A Case Study In Quality Improvement: The Kaiser Permanente Minimally Invasive Hysterementioning

confidence: 99%

Measuring Quality in Minimally Invasive Gynecologic Surgery: What, How, and Why?

Abel

Kho

Walter

et al. 2019

Journal of Minimally Invasive Gynecology

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In healthcare, the goal of maximizing value by improving the quality of care and lowering costs has been notoriously challenging to achieve. The fee-for-service model in gynecology and other fields has historically promoted the reduction of nonsurgical or minimally invasive approaches in favor of complex, often morbid procedures. In this review, we seek to define quality and value in the healthcare field and describe strategies that promote quality over production. We then discuss national, non−specialty-based efforts in the context of Surgical Care Improvement Project measures to improve quality of care. Finally, we present a case study through the Kaiser Permanente Minimally Invasive Hysterectomy Initiative, one such model that successfully built on the quality metrics of the foregoing strategies to improve patient care.

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Alternative Treatment Utilization Before Hysterectomy for Benign Gynecologic Conditions at a Large Integrated Health System

Cited by 10 publications

References 21 publications

Use of Conservative Therapies Before Hysterectomy for Uterine Leiomyomas

Use of Conservative Therapies Before Hysterectomy for Uterine Leiomyomas

Gynecologic surgery.

Measuring Quality in Minimally Invasive Gynecologic Surgery: What, How, and Why?

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