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


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.
Balas
E A
EA
Program in Health Services Management, University of Missouri, Columbia 65211, USA.
Boren
S A
SA
Brown
G D
GD
Ewigman
B G
BG
Mitchell
J A
JA
Perkoff
G T
GT
D016001:Confidence Intervals; D003625:Data Collection; D006801:Humans; D010380:Peer Review / Q000379:methods / Q000639:trends; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011787:Quality of Health Care; D016032:Randomized Controlled Trials as Topic