ArticleAmerican journal of obstetrics and gynecology2022
Development of an algorithm to assess unmeasured symptom severity in gynecologic care.
Article in American journal of obstetrics and gynecology, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed, 12 citations in OpenAlex.
- Treatment Utilization after Uterine Fibroid Diagnosis by Race and Ethnicity.Journal of women's health (2002) · 2026Article
- The Role of Self-Classified Race/Ethnicity, Insurance Status, and Hospital Type in Benign Hysterectomy.Journal of women's health (2002) · 2026Article
- Racial and ethnic differences in risk for hysterectomy following insertion of a levonorgestrel-releasing intrauterine device: A retrospective cohort study.Contraception · 2025Article
- Practice-Level Severity Case Mix and Treatment Patterns for Premenopausal Noncancerous Hysterectomy.Journal of women's health (2002) · 2025Article
- Article
- Beyond Bleeding: An Analysis of Presenting Symptoms Among Black Patients with Endometrial Cancer.Health equity · 2025Article
- Challenges and opportunities in perinatal public health: the utility of perinatal health inequality dashboards in addressing disparities in maternal and neonatal outcomes.BMC pregnancy and childbirth · 2024Article
- Appropriateness of Hysterectomy as Treatment for Benign Gynecological Conditions.Journal of women's health (2002) · 2024Article
- The Carolina hysterectomy cohort (CHC): a novel case series of reproductive-aged hysterectomy patients across 10 hospitals in the US south.BMC women's health · 2023Article
- Timeliness of diagnostic evaluation for postmenopausal bleeding: A retrospective cohort study using claims data.PloS one · 2023Article
Corrections and comments
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Authors and funding
9 authors at 4 institutions in 1 country.
Funding
Abstract
backgroundHealthcare disparities research is often limited by incomplete accounting for differences in health status by populations. In the United States, hysterectomy shows marked variation by race and geography, but it is difficult to understand what factors cause these variations without accounting for differences in the severity of gynecologic symptoms that drive the decision-making for hysterectomy.
objectiveThis study aimed to demonstrate a method for using electronic health record-derived data to create composite symptom severity indices to more fully capture relevant markers that influence the decision for hysterectomy. STUDY
designThis was a retrospective cohort study of 1993 women who underwent hysterectomy between April 4, 2014, and December 31, 2017, from 10 hospitals and >100 outpatient clinics in North Carolina. Electronic health record data, including billing, pharmacy, laboratory data, and free-text notes, were used to identify markers of 3 common indications for hysterectomy: bulk symptoms (pressure from uterine enlargement), vaginal bleeding, and pelvic pain. To develop weighted symptom indices, we finalized a scoring algorithm based on the relationship of each marker to an objective measure, in combination with clinical expertise, with the goal of composite symptom severity indices that had sufficient variation to be useful in comparing different patient groups and allow discrimination among severe symptoms of bulk, bleeding, or pain.
resultsThe ranges of symptom severity scores varied across the 3 indices, including composite bulk score (0-14), vaginal bleeding score (0-44), and pain score (0-30). The mean values of each composite symptom severity index were greater for those who had diagnostic codes for vaginal bleeding, bulk symptoms, or pelvic pain, respectively. However, each index demonstrated a variation across the entire group of hysterectomy cases and identified symptoms that ranged in severity among those with and without the target diagnostic codes.
conclusionLeveraging multisource data to create composite symptom severity indices provided greater discriminatory power to assess common gynecologic indications for hysterectomy. These methods can improve the understanding in healthcare use in the setting of long-standing inequities and be applied across populations to account for previously unexplained variations across race, geography, and other social indicators.
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Registered trials
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