{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T15:37:33Z","timestamp":1787585853560,"version":"build-2736575974"},"reference-count":38,"publisher":"SAGE Publications","issue":"10","license":[{"start":{"date-parts":[[2024,10,1]],"date-time":"2024-10-01T00:00:00Z","timestamp":1727740800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Women's Health"],"published-print":{"date-parts":[[2024,10]]},"abstract":"<jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To assess the appropriateness of hysterectomies performed at a large tertiary health system using the 1997 RAND appropriateness classification system and an updated algorithm.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Subjects:<\/jats:title>\n                    <jats:p>Patients aged 18\u201344 years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Exposure:<\/jats:title>\n                    <jats:p>Receipt of hysterectomy for benign and nonobstetric conditions from October 2014 to December 2017.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcome Measures:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1089\/jwh.2024.0142","type":"journal-article","created":{"date-parts":[[2024,6,12]],"date-time":"2024-06-12T04:13:56Z","timestamp":1718165636000},"page":"1358-1366","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":4,"title":["Appropriateness of Hysterectomy as Treatment for Benign Gynecological Conditions"],"prefix":"10.1177","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4974-2596","authenticated-orcid":false,"given":"Maya A.","family":"Wright","sequence":"first","affiliation":[{"name":"Tanaq Support Services LLC, Atlanta, Georgia, USA."},{"name":"Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA."},{"name":"The Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan C.","family":"Kinlaw","sequence":"additional","affiliation":[{"name":"The Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina, USA."},{"name":"Division of Pharmaceutical Outcomes and Policy, University of North Carolina School of Pharmacy, Chapel Hill, North Carolina, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asha B.","family":"McClurg","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin","family":"Carey","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kemi M.","family":"Doll","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, Washington, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anissa I.","family":"Vines","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew F.","family":"Olshan","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Whitney R.","family":"Robinson","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA."},{"name":"Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2024,10,8]]},"reference":[{"key":"e_1_3_7_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ogc.2016.11.007"},{"key":"e_1_3_7_3_2","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e318183fbab"},{"key":"e_1_3_7_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jmig.2018.08.013"},{"key":"e_1_3_7_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpobgyn.2017.10.001"},{"key":"e_1_3_7_6_2","doi-asserted-by":"publisher","DOI":"10.2147\/TCRM.S147318"},{"key":"e_1_3_7_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2018.05.004"},{"key":"e_1_3_7_8_2","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e318292aea4"},{"key":"e_1_3_7_9_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000279153.56275.b5"},{"key":"e_1_3_7_10_2","doi-asserted-by":"publisher","DOI":"10.1067\/mob.2002.124940"},{"key":"e_1_3_7_11_2","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e3181cf46a0"},{"key":"e_1_3_7_12_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2016.0804"},{"key":"e_1_3_7_13_2","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e318299a6cf"},{"key":"e_1_3_7_14_2","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD000154.pub3"},{"key":"e_1_3_7_15_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000230214.26638.0c"},{"key":"e_1_3_7_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jmig.2010.10.001"},{"key":"e_1_3_7_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2017.11.033"},{"key":"e_1_3_7_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jogoh.2018.11.004"},{"key":"e_1_3_7_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2005.09.056"},{"key":"e_1_3_7_20_2","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000001592"},{"key":"e_1_3_7_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.mayocp.2016.08.002"},{"key":"e_1_3_7_22_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehq477"},{"key":"e_1_3_7_23_2","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e318236fd12"},{"key":"e_1_3_7_24_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2021.2631"},{"key":"e_1_3_7_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2021.08.038"},{"key":"e_1_3_7_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ehb.2010.01.002"},{"issue":"3","key":"e_1_3_7_27_2","first-page":"45","article-title":"Native American women and forced sterilization, 1973-1976","volume":"8","author":"Jarrell RH","year":"1992","unstructured":"Jarrell RH. 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