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

117 Citations (Scopus)

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

Fingerprint

Meta-Analysis
Randomized Controlled Trials
Odds Ratio
Physicians
Multilevel Analysis
American Medical Association
Economics
Confidence Intervals

Keywords

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

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Effect of physician profiling on utilization : Meta-analysis of randomized clinical trials. / Balas, E Andrew; Boren, Suzanne Austin; Brown, Gordon D.; Ewigman, Bernard G.; Mitchell, Joyce A.; Perkoff, Gerald T.

In: Journal of General Internal Medicine, Vol. 11, No. 10, 01.01.1996, p. 584-590.

Research output: Contribution to journalArticle

Balas, E Andrew ; Boren, Suzanne Austin ; Brown, Gordon D. ; Ewigman, Bernard G. ; Mitchell, Joyce A. ; Perkoff, Gerald T. / Effect of physician profiling on utilization : Meta-analysis of randomized clinical trials. In: Journal of General Internal Medicine. 1996 ; Vol. 11, No. 10. pp. 584-590.
@article{325256b603144018b2be07c8c8733460,
title = "Effect of physician profiling on utilization: Meta-analysis of randomized clinical trials",
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.",
keywords = "clinical trials, health services research, meta-analysis, physician's practice patterns, randomized controlled trials",
author = "Balas, {E Andrew} and Boren, {Suzanne Austin} and Brown, {Gordon D.} and Ewigman, {Bernard G.} and Mitchell, {Joyce A.} and Perkoff, {Gerald T.}",
year = "1996",
month = "1",
day = "1",
doi = "10.1007/BF02599025",
language = "English (US)",
volume = "11",
pages = "584--590",
journal = "Journal of General Internal Medicine",
issn = "0884-8734",
publisher = "Springer New York",
number = "10",

}

TY - JOUR

T1 - Effect of physician profiling on utilization

T2 - Meta-analysis of randomized clinical trials

AU - Balas, E Andrew

AU - Boren, Suzanne Austin

AU - Brown, Gordon D.

AU - Ewigman, Bernard G.

AU - Mitchell, Joyce A.

AU - Perkoff, Gerald T.

PY - 1996/1/1

Y1 - 1996/1/1

N2 - 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.

AB - 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.

KW - clinical trials

KW - health services research

KW - meta-analysis

KW - physician's practice patterns

KW - randomized controlled trials

UR - http://www.scopus.com/inward/record.url?scp=0029833149&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0029833149&partnerID=8YFLogxK

U2 - 10.1007/BF02599025

DO - 10.1007/BF02599025

M3 - Article

C2 - 8945689

AN - SCOPUS:0029833149

VL - 11

SP - 584

EP - 590

JO - Journal of General Internal Medicine

JF - Journal of General Internal Medicine

SN - 0884-8734

IS - 10

ER -