An assessment of prostatectomy for benign urinary tract obstruction. Geographic variations and the evaluation of medical care outcomes

IN MAINE, the efforts of practicing urologists to understand how their clinical decisions contribute to the striking variations in rates of prostatectomy from one community to another led to a critical evaluation of the theories under See also pp 3010 and 3018. lying the decision to operate. Specific aspects of our work have been described elsewhere.1-3The purpose of this report is to provide an overview of the prostatectomy assessment project—its background and relevance, the methods used, the principal findings and recommendations—and to comment on the applicability of the approach to the evaluation of other common medical practices. BACKGROUND The project was an initiative of the Maine Medical Assessment Program,4,5an ongoing program sponsored by the Maine Medical Association to respond to the small-area variations in medical practice patterns seen among Maine communities. Striking geographic variations in use are characteristic of many operations, diagnostic procedures, and causes of