Fibroid treatment rates over time at a single academic medical system

Background: Multidisciplinary collaboration has generally been shown to
have positive effects on healthcare but can be difficult to facilitate.
This study assessed the effects of a multidisciplinary fibroid clinic on
practice patterns and clinician perceptions to better understand drivers
of interspecialty collaboration. Materials and Methods: Annual rates of
hysterectomies, myomectomies, and uterine fibroid embolizations (UFEs)
performed in an urban healthcare system were collected from 2012-2019.
Rates of each procedure were compared over time before and after launching
a multidisciplinary fibroid clinic at the academic medical center.
Referral rates were also compared. The gynecologists and interventional
radiologists (IRs) involved in the clinic were interviewed 2 years prior
to and after the clinic launch about their approaches to fibroids and
perceptions of others who treat this condition. A phenomenological
approach was used to identify and compare themes within the interviews by
two researchers with excellent inter-rater agreement (k = 0.80). Results
and Discussion: Annual rates of fibroid procedures increased over time
(p<0.01) but the relative number of UFEs decreased (p=0.01). UFE
referrals by the clinic gynecologists significantly increased as did the
number of combined fibroid procedures (p<0.01). However, the rates
of one fibroid procedure relative to others were not different between the
clinic and rest of the healthcare system (p=0.55). Specialty-specific
perceptions of fibroid treatments and inter-specialty dynamics did not
change. Despite this, clinicians unanimously perceived the clinic and
post-clinic practice patterns as positive and distinct from their previous
work and relationships between gynecology and IR elsewhere. Limitations of
this study included its single clinic design and potential confounder of
differences in advertising pre- versus post-clinic. Conclusion: Creating
the right practice environment may be more important for fostering
inter-specialty collaboration and work satisfaction than shared mental
models or procedural volumes in certain practice settings.