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Geographic variation in lumbar diskectomy: a protocol for evaluation
1Maryland Hospital Education Institute, Lutherville.
Abstract:
In 1989 the Maryland Hospital Association (MHA) began developing a protocol related to lumbar diskectomy, a procedure with widely reported geographic variation in its use. The MHA's Laminectomy Advisory Committee drafted three criteria for performance of lumbar diskectomy and also developed a data-collection instrument with which the eight hospitals participating in a pilot study could abstract the necessary data from medical records. Both individual hospital and aggregate results showed wide variation in compliance with the criteria. These findings suggest research and development activities such as refinement of the data-collection instrument, use of the protocol for bench-marking, further investigation of clinical and other determinants of rate variation, and study of the effect of new diagnostic technology on utilization rates for this procedure.
Insights
The Maryland Hospital Association developed lumbar diskectomy criteria, finding significant geographic variation in compliance among pilot hospitals. Further research is needed to understand and address these utilization rate differences.
Area of Science:
- Health Services Research
- Surgical Outcomes Research
- Healthcare Quality Improvement
Background:
- Geographic variation in surgical procedure rates, including lumbar diskectomy, is a recognized issue in healthcare.
- The Maryland Hospital Association (MHA) initiated efforts to standardize lumbar diskectomy protocols due to observed utilization disparities.
Purpose of the Study:
- To develop and pilot a protocol with defined criteria for lumbar diskectomy performance.
- To assess compliance with the developed criteria across participating hospitals.
- To identify variations in the application of lumbar diskectomy procedures.
Main Methods:
- Development of three key criteria for lumbar diskectomy by the MHA's Laminectomy Advisory Committee.
- Creation of a data-collection instrument for abstracting information from medical records.
- Pilot study involving eight hospitals to evaluate protocol compliance using the data instrument.
Main Results:
- Significant variation in compliance with the established lumbar diskectomy criteria was observed at both individual hospital and aggregate levels.
- The pilot study highlighted disparities in the application of the protocol across participating healthcare facilities.
Conclusions:
- Findings indicate a need for further research and development to refine data collection and protocol implementation.
- Recommendations include using the protocol for benchmarking, investigating determinants of rate variation, and studying the impact of new diagnostic technologies on lumbar diskectomy utilization.
