Utah has historically had higher than average hysterectomy rates — particularly in women over 40 years old who’ve finished having children and who’re seeking medical attention for abnormal uterine bleeding. A hysterectomy is a common surgical procedure that removes a woman’s uterus. It’s a major surgery and the conditions leading to it can often be treated by alternative treatments. Intermountain's Women and Newborn Clinical Program set a goal last year to reduce the number of hysterectomies we perform and provide less invasive alternative therapies instead. Thanks to providers and caregivers across the system working together as One Intermountain, we’ve had phenomenal results.
“Hysterectomies are highly invasive, require a lengthy recovery time, and are costly,” says Kristi Nelson, clinical improvement leader for the Women and Newborn Clinical Program. “Providing women with alternative treatments helps them recover faster, have less pain, and saves them a lot of money.”
Kristi worked alongside Sara Jane Pieper, MD, a Medical Group gynecologist and former medical director of the Gynecology Development Team, to set a 2018 systemwide goal for reducing hysterectomies. They used SelectHealth data from 2017 that demonstrated Intermountain’s hysterectomy rate was nearly double the national average, and 60 percent of women having a hysterectomy for abnormal uterine bleeding had no prior medical intervention prior to surgery.
Abnormal uterine bleeding is a common condition where women have heavy menstrual bleeding or bleeding between periods. It can be caused by a variety of conditions that can be corrected without a hysterectomy — specifically by using either a hormonal intrauterine device (IUD) or through endometrial ablation, a less invasive surgical procedure that destroys the lining of the uterus and reduces abnormal uterine bleeding.
Kristi Nelson
“The 2018 systemwide goal was to reduce hysterectomies in women with a diagnosis of abnormal uterine bleeding by 6.5 percent, and we surpassed it, achieving a 12.5 percent reduction,” says Kristi. “We reached the goal by focusing on evidence-based standards of care and utilization of non-surgical modalities.”
To implement the goal, the Women and Newborns Clinical Program and the Gynecology Development Team updated a care process model to follow national evidence-based standards of care for abnormal uterine bleeding and medical management options. They also worked with SelectHealth to change preauthorization criteria for hysterectomies. A team of physicians from across the system participated in the committee that led the change.
Sara Jane Pieper, MD
“We wanted to make sure women tried other therapies first instead of going straight to a hysterectomy,” says Kristi. “In younger women with abnormal uterine bleeding who want to preserve their fertility we treat with alternative medical therapies, and we needed to be more proactive with everyone.”
Several Utah insurance companies, in addition to SelectHealth, have also started a preauthorization process for hysterectomies. The current standard of care is a minimum of three months of medical therapy prior to proceeding with surgical management.
Kristi says the team’s work continues and Intermountain is continuing to monitor hysterectomy rates compared to national rates. They expect to see further reductions in the future.