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Value of the Periodic Health Evaluation
Evidence Reports/Technology Assessments, No. 136
L Ebony Boulware, MD, MPH, George J Barnes, II, BA, Renee F Wilson, MSc, Karran Phillips, MD, MPH, Kenric Maynor, MD, Constance Hwang, MD, Spyridon Marinopoulos, MD, MBA, Dan Merenstein, MD, Patricia Richardson-McKenzie, MD, MPH, Eric B Bass, MD, MPH, Neil R Powe, MD, MPH, MBA, and Gail L Daumit, MD, MHS, Investigators.
Structured Abstract
Objective:
To systematically review evidence on definitions of the periodic health evaluation (PHE), its associated benefits and harms, and system-level interventions to improve its delivery.
Data Sources:
Electronic searches in MEDLINE®, and other databases; hand searching of 24 journals and bibliographies through February 2006.
Review Methods:
Paired investigators abstracted data and judged study quality using standard criteria. We reported effect sizes for mean differences and proportions in randomized controlled trials (RCTs). We adapted GRADE Working Group criteria to assess quantity, quality and consistency of the best evidence pertaining to each outcome, assigning grades of “high,” “medium,” “low,” or “very low.”
Results:
Among 36 identified studies (11 RCTs), definitions of the PHE varied widely. In studies assessing benefits, the PHE consistently improved (over usual care) the delivery/receipt of the gynecological exam/Pap smear (2 RCTs, small effect (Cohen's d (95% confidence interval (CI)): 0.07 (0.07,0.07)) to large effect (Cohen's d (CI): 1.71 (1.69, 1.73)), strength and consistency graded “high”); cholesterol screening (1 RCT, small effect (Cohen's d (CI): 0.02 (0.00,0.04)) with large associations in 4 observational studies, graded “medium”); and fecal occult blood testing (2 RCTs, large effects (Cohen's d (CI): 1.19 (1.17, 1.21) and 1.07 (1.05, 1.08)), graded “high”). Effects of the PHE were mixed among studies assessing delivery/receipt of counseling (graded “low”), immunizations (graded “medium”) and mammography (graded “low”). In one RCT, the PHE led to a smaller increase in patient “worry” (13%) compared to usual care (23%) (graded “medium”). The PHE had mixed effects on serum cholesterol (graded “low”), blood pressure, body mass index, disease detection, health habits and health status (graded “medium”). The PHE had mixed effects on hospitalization (graded “high”) costs, disability, and mortality (graded “medium”). No studies assessed harms. Delivery of the PHE was improved by scheduling of appointments for PHE (1 RCT, medium effects (Cohen's d (CI): 0.69 (0.68, 0.70)) and offering a free PHE (1 non-RCT, 22% increase) (graded “medium”).
Conclusions:
The evidence suggests delivery of some recommended preventive services are improved by the PHE and may be more directly affected by the PHE than intermediate or long-term clinical outcomes and costs. Descriptions of the PHE and outcomes were heterogeneous, and some trials were performed before dissemination of guidelines by the U.S. Preventive Services Task Force, limiting interpretations of findings. Efforts are needed to clarify the long-term benefits of receiving multiple preventive services in the context of the PHE. Future studies assessing the PHE should incorporate diverse populations, carefully define comparisons to “usual care,” and comprehensively assess intermediate outcomes, harms, and costs.
Contents
- Preface
- Acknowledgments
- Executive Summary
- 1. Introduction
- The Periodic Health Evaluation
- Historical Changes in Conceptualization of the Content and Value of the PHE
- National Task Forces to Evaluate Preventive Care and the PHE
- Continued Use of the PHE Despite Recommendations
- Private Insurance Coverage for the PHE
- Centers for Medicare and Medicaid Service (CMS) Legislation and the PHE
- Need for Review of the Evidence on the Value of the PHE
- 2. Methods
- Recruitment of Technical Experts and Peer Reviewers
- Key Questions
- Conceptual Framework
- Literature Search Methods
- Title Review
- Abstract Review
- Article Inclusion/Exclusion
- Article Review
- Article Quality Assessment
- Data Entry and Quality Control
- Grading of the Evidence
- Estimating the Magnitude of Effect of the PHE on Outcomes in RCTs
- Peer Review
- 3. Results
- Results of Literature Search and Abstract Review Process
- Results of Article Inclusion/Exclusion Process
- General Study Characteristics
- Key Question 1: What Definitions are Used for the Adult PHE in Studies of its Value?
- Key Question 2: What is the Evidence that a PHE, Delivered at Different Patient Ages or Different Frequencies, is Associated with Benefits Compared to Care Without a PHE?
- Key Question 3: What is the Evidence that a PHE, Delivered at Different Patient Ages or Different Frequencies, Is Associated with Harms Compared to Care Without a PHE?
- Key Question 4: What System-based Interventions Improve the Receipt or Delivery of the PHE?
- 4. Discussion
- Summary Tables
- Appendixes
- References and Included Studies
Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services.1 Contract No. 290-02-0018. Prepared by: The Johns Hopkins University Evidence-based Practice Center, Baltimore, MD.
Suggested citation:
Boulware LE, Barnes GJ, Wilson RF, Phillips K, Maynor K, Hwang C, Marinopoulos S, Merenstein D, Richardson-McKenzie P, Bass EB, Powe NR, Daumit GL. Value of the Periodic Health Evaluation. Evidence Report/Technology Assessment No. 136. (Prepared by The Johns Hopkins University Evidence-based Practice Center under Contract No. 290-02-0018). AHRQ Publication No. 06-E011. Rockville, MD: Agency for Healthcare Research and Quality.
This report is based on research conducted by the Johns Hopkins University Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-02-0018).The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
The information in this report is intended to help clinicians, employers, policymakers, and others make informed decisions about the provision of health care services. This report is intended as a reference and not as a substitute for clinical judgment.
This report may be used, in whole or in part, as the basis for the development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.
The investigators have no relevant financial interests in the report. The investigators have no employment, consultancies, honoraria, or stock ownership or options, or royalties from any organization or entity with a financial interest or financial conflict with the subject matter discussed in the report.
- 1
540 Gaither Road, Rockville, MD 20850. www
.ahrq.gov
- Review Systematic review: the value of the periodic health evaluation.[Ann Intern Med. 2007]Review Systematic review: the value of the periodic health evaluation.Boulware LE, Marinopoulos S, Phillips KA, Hwang CW, Maynor K, Merenstein D, Wilson RF, Barnes GJ, Bass EB, Powe NR, et al. Ann Intern Med. 2007 Feb 20; 146(4):289-300.
- Preventive health care, 2000 update: prevention of child maltreatment.[CMAJ. 2000]Preventive health care, 2000 update: prevention of child maltreatment.MacMillan HL, Canadian Task Force on Preventive Health Care. CMAJ. 2000 Nov 28; 163(11):1451-8.
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- Effect of periodic health exam on provider management of preventive services.[J Eval Clin Pract. 2019]Effect of periodic health exam on provider management of preventive services.Hoang PT, Hodgkin D, Thomas JP, Ritter G, Chilingerian J. J Eval Clin Pract. 2019 Oct; 25(5):827-833. Epub 2018 Nov 29.
- Review Systematic review of U.S.-based randomized controlled trials using community health workers.[Prog Community Health Partners...]Review Systematic review of U.S.-based randomized controlled trials using community health workers.Gibbons MC, Tyus NC. Prog Community Health Partnersh. 2007 Winter; 1(4):371-81.
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