The Doctors’ Effect on Patients’ Physical Health Outcomes Beyond the Intervention: A Methodological Review

Abstract

Background

Previous research suggests that when a treatment is delivered, patients’ outcomes may vary systematically by medical practitioner.

Objective

To conduct a methodological review of studies reporting on the effect of doctors on patients’ physical health outcomes and to provide recommendations on how this effect could be measured and reported in a consistent and appropriate way.

Methods

The data source was 79 included studies and randomized controlled trials from a systematic review of doctors’ effects on patients’ physical health. We qualitatively assessed the studies and summarized how the doctors’ effect was measured and reported.

Results

The doctors’ effects on patients’ physical health outcomes were reported as fixed effects, identifying high and low outliers, or random effects, which estimate the variation in patient health outcomes due to the doctor after accounting for all available variables via the intra-class correlation coefficient. Multivariable multilevel regression is commonly used to adjust for patient risk, doctor experience and other demographics, and also to account for the clustering effect of hospitals in estimating both fixed and random effects.

Conclusion

This methodological review identified inconsistencies in how the doctor’s effect on patients’ physical health outcomes is measured and reported. For grading doctors from worst to best performances and estimating random effects, specific recommendations are given along with the specific data points to report.

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Keywords:

• methodological study
• meta-epidemiology
• meta-epidemiological review
• research methods
• doctors’ effect

Ethical Approval

As this is a methodological review, no ethical approval was required.

Acknowledgments

The authors thank Dr Aya Ashraf Ali and Tulia Gonzalez Flores for their excellent editorial contributions.

The authors thank Dr Rachel Mascord for her support during the systematic review.

Author Contributions

Both authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare no support from any organization for the submitted work, no financial relationships with any organizations that might have an interest in the submitted work in the previous three years, and no other relationships or activities that could appear to have influenced the submitted work. The lead author affirms that the manuscript is an honest, accurate, and transparent account of the study being reported, that no important aspects of the study have been omitted, and that any discrepancies from the study as originally planned (and, if relevant, registered) have been explained.

Additional information

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.