PORTLAND (AP) – An analysis of geographic differences in the use of various surgical procedures within Maine is drawing the attention of the state’s health care providers.

The Maine Quality Forum found, for example, that hysterectomies for problems other than cancer were performed 57 percent more often on women in the Skowhegan area than on other Maine women.

Operations in the Lewiston-Auburn area to ease lower back problems were performed 124 percent more than expected, the quality forum found. And use of carotid endarterectomy, an operation intended to prevent strokes, was up to 176 percent greater in northern Aroostook County.

There is no conclusive evidence to explain the geographic differences, and Dr. Dennis Shubert, executive director of the quality forum, said posting the results late last year on www.mainequalityforum.gov was not meant as an indictment of certain providers.

There have been concerns that making the information public might unduly alarm patients, who can log onto the Web site to look up seven procedures and see how commonly they are performed in their area.

The goal, said Shubert, is to educate patients and open a dialogue between surgeons and referring doctors.

Dr. Roger Renfrew, a primary care doctor and medical director of Redington-Fairview General Hospital in Skowhegan, said the data confirmed his sense that Skowhegan saw a high number of hyterectomies among women with uterine fibroids and chronic bleeding.

As a result, he has called for an internal review of whether hysterectomies were necessary in all cases and whether less drastic options such as hormone therapy or removal of the endometrial lining were properly explored.

Renfrew said he does not feel that anything inappropriate has taken place.

Rather, “we really see this as an opportunity to improve our care and to make sure that our care is appropriate,” Renfrew said. “I look at this not as something that is necessarily a black mark, but it is just a challenge for us to know more.”

Not everyone has embraced the data.

The state’s hospital and medical associations say the information used by the quality forum is incomplete.

They note that the 1998-2002 data is drawn from insurance claims. Billing forms, the trade groups say, consist of number codes that don’t explain why a doctor ordered a certain treatment.

“In their rush to post data on the Web site, they chose to use existing claims data which is not appropriate for evaluating the quality of care in Maine,” said Mary Mayhew, vice president of government affairs for the Maine Hospital Association.

Critics also say the quality forum implies there is a “correct” rate of procedures. Variation could be influenced, some observers say, by the availability of a certain procedure or the health of an area’s population.



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