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Journal of General Internal Medicine

, Volume 11, Issue 10, pp 584–590 | Cite as

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
Original Articles

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.

Key words

clinical trials health services research metaanalysis physician’s practice patterns randomized controlled trials 

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Copyright information

© Blackwell Science, Inc. 1996

Authors and Affiliations

  • E. Andrew Balas
    • 1
    • 2
  • Suzanne Austin Boren
    • 1
  • Gordon D. Brown
    • 1
  • Bernard G. Ewigman
    • 3
  • Joyce A. Mitchell
    • 2
  • Gerald T. Perkoff
    • 3
  1. 1.the Program in Health Services ManagementUniversity of MissouriColumbia
  2. 2.Medical Informatics GroupUniversity of MissouriColumbia
  3. 3.Department of Family and Community MedicineUniversity of MissouriColumbia

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