Effect of physician profiling on utilization - Meta-analysis of randomized clinical trials
Effect of physician profiling on utilization - Meta-analysis of randomized clinical trials
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DOI：
10.1007/bf02599025
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发表时间：
1996-10-01
影响因子：
5.7
通讯作者：
Perkoff, GT
中科院分区：
文献类型：
--
作者：
Balas, EA;Baren, SA;Perkoff, GT
美国医学协会的一项调查报告说，超过一半的医生是临床或经济分析的对象。这种多层次的荟萃分析的目的是评估同行比较反馈干预（配置文件）在不断变化的实践patterns.METHODS：系统的计算机和手动搜索相结合，检索随机对照临床试验测试分析报告的文章的临床效果。符合条件的研究是随机对照临床试验，测试同行比较反馈干预和测量临床程序的利用。为了使用所有可用的信息，数据被提取并在三个水平上进行分析：（1）效应方向，（2）统计比较的p值，（3）比值比（OR）。12项研究（水平1）的计票符号检验的检验结果为p <0.05，8项研究（水平2）的z转换检验的检验结果为p <0.05。OR分析中纳入了5项试验（3级）。5项试验中有2项的主要效应变量的OR不显著。然而，总体OR计算的Mantel-Haenszel方法是显着的（1.091，置信区间：1.045至1.136）。结论：轮廓有统计学意义，但最小的影响，利用临床程序。这项研究的结果表明，需要进行控制的临床评价之前，大量的医生利用管理干预措施。
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 ham 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 far 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, hut 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.