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Effect of physician profiling on utilization

Meta-analysis of randomized clinical trials

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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 wasp<.05 for the vote-counting sign test of 12 studies (level 1) andp<.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.

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Authors and Affiliations

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

    E. Andrew Balas MD, PhD, Suzanne Austin Boren MHA & Gordon D. Brown PhD

  2. Medical Informatics Group, University of Missouri, Columbia

    E. Andrew Balas MD, PhD & Joyce A. Mitchell PhD

  3. Department of Family and Community Medicine, University of Missouri, Columbia

    Bernard G. Ewigman MD, MSPH & Gerald T. Perkoff MD

Authors
  1. E. Andrew Balas MD, PhD
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  2. Suzanne Austin Boren MHA
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  3. Gordon D. Brown PhD
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  4. Bernard G. Ewigman MD, MSPH
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  5. Joyce A. Mitchell PhD
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  6. Gerald T. Perkoff MD
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Additional information

Supported in part by the Agency for Health Care Policy and Research grant HS07715 and in part by National Library of Medicine grant LM05545.

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Balas, E.A., Boren, S.A., Brown, G.D. et al. Effect of physician profiling on utilization. J Gen Intern Med 11, 584–590 (1996). https://doi.org/10.1007/BF02599025

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