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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.

Agency for Healthcare Research and Quality (US)2006 Apr

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## 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

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                        - 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 of Main Findings
                          - Limitations
                          - Recommendations for Future Research
                          - Conclusions
                        - Summary Tables
                        - Appendixes                           - Appendix A: Technical Experts and Peer Reviewers
                          - Appendix B: Hand Searched Journals
                          - Appendix C: Exact Search Strategies
                          - Appendix D: Example Review Forms
                          - Appendix E: Listing of Included and Excluded Articles
                          - Appendix F: Study Nomenclature
                          - Appendix G: Evidence Tables
                        - References and Included Studies

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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

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Bookshelf ID: NBK38044

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                    - Cite this Page Boulware LE, Barnes GJ II, Wilson RF, et al. Value of the Periodic Health Evaluation. Rockville (MD): Agency for Healthcare Research and Quality (US); 2006 Apr. (Evidence Reports/Technology Assessments, No. 136.)

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