It was almost certainly reviewed by other physicians only, because the analysis problems jump out at anyone who has studied the literature on statistical methods for meta-analysis.
After reading a number of @Sander papers as well as following up on his references, I would agree with him that statistics needs to be taught from an information theoretic perspective.
When this is done, all of the recommendations provided by @f2harrell in his numerous posts, BBR, and RMS, make sense.
A large part of the reason there are “loud voices” is because financial risk is being placed on U.S. health care organizations, whether they like it or not.
The key modification:
Blockquote
Value-based arrangements where the value-based enterprise assumes substantial downside financial risk. This safe harbor covers both monetary and in-kind remuneration exchanges between a VBE and a VBE participant in a VBE that assumes substantial downside financial risk from a payer if the VBE participant assumes a meaningful share of the risk. This safe harbor offers greater flexibility than the care coordination arrangements safe harbor. The OIG finalized this safe harbor with industry-friend modifications. For one of the four different payment methodologies used to determine “substantial downside financial risk,” the OIG reduced the risk threshold (i.e., the VBE has repayment obligation of 30% of shared losses rather than 30%). While the proposed rule defined “meaningful share of the risk” to mean at least 8%, the OIG reduced this amount, requiring the VBE participant to share at least 5% of the financial risk to qualify.
As more U.S. physicians work as employees of VBE, with financial management being delegated to non-clinicians, we are placing primary care physicians in the position of making complicated actuarial calculations with little supporting infrastructure.
The non-clinical financial managers, in turn, have little incentive to implement appropriate decision support structures when a MA like this gets “peer reviewed” and published. Any failure in the financial performance of the organization will be suffered by those on the front lines. This is a prime reason for physician burnout in the United States.
It was my motivation for creating this thread on clinical practice guidelines. I can easily imagine cases where clinical practice guidelines would discourage even the most motivated clinician from providing the appropriate individual treatment, due to a misunderstanding by non-clinical managers on proper interpretation of clinical guidelines.
A vast number of retrospective meta-analyses (especially in my field of rehabilitation) attempt to use methods of synthesis when the information collected cannot support it – ie. there is too much entropy in the channel.
As was shown in the classic paper by J.L Kelly, there is a close relationship between information compression/synthesis, and the valuation of courses of action (ie. decisions). Appropriate methods of analysis, made explicit to all stakeholders, can simultaneously support clinicians in their job to aid patients making the best individual decision, while also helping the institution better manage financial risk.