Doctoral Dissertations

Date of Award

8-2000

Degree Type

Dissertation

Degree Name

Doctor of Philosophy

Major

Human Ecology

Major Professor

Robert J. Pursley

Committee Members

Debra C. Wallace, Robert H. Kirk, Bill C. Wallace

Abstract

Even though the results of before-and-after studies on physician profiling vary, profiles continue to be used widely as a vehicle for information feedback to change physician utilization practice patterns. The purpose of this study was to assess the impact of physician profiling and information sharing in modifying practice patterns among HMO primary care physicians within a managed care plan in the state of Teimessee. All commercial HMO primary care physicians from the plan were included in the study, as part of a pre-intervention/post-intervention quasi-experimental design. The experimental group (physicians receiving profiles) consisted of 463 physicians, whereas the control group (physicians not receiving profiles) consisted of 1,213 physicians. The pre-intervention period was calendar year 1998 and the post-intervention period was calendar year 1999. In addition, rural and urban physicians were analyzed within each of the groups. Non-parametric (Wilcoxon Rank Sum, Wilcoxon Signed Rank, and Chi-square) test-statistics were used to test for differences between and within groups across 7 utilization measures (primary care visits PMPY, specialist visits PMPY, number of prescriptions PMPY, proportion of generic prescriptions written, inpatient admissions/1000 members PY, emergency room visits/1000 members PY, outpatient surgeries/1000 members PY) and 3 quality measures (cholesterol screening rate, mammography screening rate, and Hemoglobin Ale screening rate). All utilization measures were case-mix adjusted using the Johns Hopkins Adjusted Clinical Groups (ACGs). Results showed significant improvement (p < 0.05) in 5 of the 7 utilization measures, from pre-intervention to post-intervention, in the experimental group. Only 3 of the 7 utilization measures showed significant improvement, from pre-intervention to post-intervention, in the control group. The rural group showed significantly lower (p < 0.05) utilization than the urban group. However, urban physicians were more responsive to physician profiling than rural physicians. No significant improvement was seen in the quality measures from pre-intervention to post-intervention across all groups. The research concludes that physician profiling is effective in changing practice patterns for the utilization measures, but not for the quality measures. Additional interventions are needed to improve the quality screening measures. Potential underutilization among the rural physicians needs to be addressed.

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