Effect of physician profiling on utilization: Meta-analysis of randomized clinical trials

E. Andrew Balas, Suzanne Austin Boren, Gordon D. Brown, Bernard G. Ewigman, Joyce A. Mitchell, Gerald T. Perkoff

Research output: Contribution to journalArticle

118 Scopus citations

Abstract

OBJECTIVES: An American Medical Association survey reported that more than half of physicians are subjects of either clinical or economic profiling. This multilevel meta-analysis was designed to assess the clinical effect of peer-comparison feedback intervention (profiles) in changing practice patterns. METHODS: Systematic computerized and manual searches were combined to retrieve articles on randomized controlled clinical trials testing profiling reports. Eligible studies were randomized, controlled clinical trials that tested peer-comparison feedback intervention and measured utilization of clinical procedures. To use all available information, data were abstracted and analyzed on three levels: (1) direction of effects, (2) p value from the statistical comparison, and (3) odds ratio (OR). MAIN RESULTS: In the 12 eligible trials, 553 physicians were profiled. The test result was p < .05 for the vote-counting sign test of 12 studies (level 1) and p < .05 for the z-transformation test of 5 studies (level 2). There were 5 trials included in the OR analysis (level 3). The primary effect variable in two of the 5 trials had a nonsignificant OR. However, the overall OR calculated by the Mantel-Haenszel method was significant (1.091, confidence interval: 1.045 to 1.136). CONCLUSIONS: Profiling has a statistically significant, but minimal effect on the utilization of clinical procedures. The results of this study indicate a need for controlled clinical evaluations before subjecting large numbers of physicians to utilization management interventions.

Original languageEnglish (US)
Pages (from-to)584-590
Number of pages7
JournalJournal of General Internal Medicine
Volume11
Issue number10
DOIs
StatePublished - Jan 1 1996
Externally publishedYes

Keywords

  • clinical trials
  • health services research
  • meta-analysis
  • physician's practice patterns
  • randomized controlled trials

ASJC Scopus subject areas

  • Internal Medicine

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