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J Gen Intern Med. 1996 Oct;11(10):584-90.

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

Author information

1
Program in Health Services Management, University of Missouri, Columbia 65211, USA.

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 fro 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 8 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.

Comment in

  • ACP J Club. 1997 May-Jun;126(3):81.
PMID:
8945689
DOI:
10.1007/bf02599025
[Indexed for MEDLINE]

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