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Effect of physician profiling on utilization. Meta-analysis of randomized clinical trials
E A Balas1, S A Boren, G D Brown
1Program in Health Services Management, University of Missouri, Columbia 65211, USA.
Journal of General Internal Medicine
|October 1, 1996
Summary
Peer-comparison feedback, or profiling, shows a statistically significant but minimal impact on physician practice patterns. Further controlled evaluations are needed before widespread implementation of utilization management interventions.
Area of Science:
- Health Services Research
- Medical Practice Management
- Physician Performance Measurement
Background:
- Physician profiling is common, with over half of doctors subjected to clinical or economic profiling.
- Peer-comparison feedback interventions aim to modify physician practice patterns.
Purpose of the Study:
- To conduct a multilevel meta-analysis assessing the clinical impact of peer-comparison feedback (profiling) on physician practice patterns.
Main Methods:
- Systematic literature searches (computerized and manual) identified randomized controlled trials of profiling interventions.
- Data from 12 eligible trials were analyzed on three levels: direction of effects, p-values, and odds ratios (OR).
Main Results:
- Analysis of 12 trials (553 physicians) indicated a statistically significant effect (p < .05) on clinical procedures.
- The overall odds ratio (OR) was significant (1.091, CI: 1.045–1.136), suggesting a minimal but detectable impact.
Conclusions:
- Physician profiling yields a statistically significant, yet minimal, effect on the utilization of clinical procedures.
- Controlled clinical evaluations are recommended prior to broad application of utilization management interventions for physicians.