Annals of Internal Medicine is published by the American College of Physicians-American Society of Internal Medicine (ACP-ASIM), an organization of more than 115,000 internal medicine physicians and medical students. The following highlights are not intended to substitute for articles as sources of information. For an embargoed fax of an article, call 1-800-523-1546, ext. 2656 or 215-351-2656.
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Physician profiling is the practice of comparing individual doctors or clinics. Accurate profiling is in the best interest of patients, doctors, and the public. In this study, the initial analysis of physician care of diabetic patients found differences in care between generalists and subspecialist endocrinologists. But when the researchers used statistical techniques to account for both differences in patient characteristics and differences between clinics, the differences between physician specialties disappeared (Article, p. 111). The authors note that most national quality-of-care initiatives fail to adjust adequately for patient characteristics and none adjust for variations between individual physicians or practices. An editorial outlines questions that consumers should ask when looking at physicians and health practice profiles: Does the information take into account how sick the case-mixes of the groups' patients were? Is the number of cases in each group large enough to accurately represent typical practice patterns? Do the performance measures reflect the possibility that similar patients and physicians cluster into certain types of practices? (Editorial, p. 153).
Using a computer model, researchers estimated the effectiveness and cost of various procedures in investigating rectal bleeding in people aged 25 to 45 years old (Article, p. 99). The most expensive of the procedures, colonoscopy - examination of the entire colon using a fiberoptic instrument - is considered appropriate for people with rectal bleeding older than age 45 because colorectal cancer is common in older people. The study found that, compared with other procedures, colonoscopy increased life expectancy and became more cost-effective as the patient's age increased. The most cost-effective strategy to investigate rectal bleeding depends on the patient's age, the cost of the procedures, the specialist involved, and the perspective of the decision maker, the authors say.