Disparities in Quality of Primary Care by Resident and Staff Physicians: Is There a Conflict Between Training and Equity?
| Autor: | Alaka Ray, Jonathan Abraham, Yuchiao Chang, Wei He, Steven J. Atlas, Utibe R. Essien, Daniel E. Singer |
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| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Adult
Male medicine.medical_specialty 01 natural sciences Physicians Primary Care Coronary artery disease Cohort Studies 03 medical and health sciences 0302 clinical medicine Diabetes mellitus Cancer screening Internal Medicine Medicine Humans 030212 general & internal medicine Longitudinal Studies Patient Reported Outcome Measures 0101 mathematics Letter to the Editor Quality of Health Care Retrospective Studies Original Research Health Equity Primary Health Care business.industry 010102 general mathematics Internship and Residency Retrospective cohort study Emergency department Middle Aged medicine.disease Health equity Disadvantaged Family medicine Ambulatory Female business |
| Zdroj: | J Gen Intern Med |
| Popis: | BACKGROUND: Outpatient primary care experience is vital to internal medicine resident training but may impact quality and equity of care delivered in practices that include resident physicians. Understanding whether quality differences exist among resident and staff primary care physicians (PCPs) may present an opportunity to address health disparities within academic medical centers. OBJECTIVE: To determine whether there are differences in the quality of primary care provided by resident PCPs compared to staff PCPs. DESIGN: A retrospective cohort study with a propensity-matched analysis. PARTICIPANTS: 143,274 patients, including 10,870 patients managed by resident PCPs, seen in 16 primary care practices affiliated with an academic medical center. MAIN MEASURES: Guideline-concordant chronic disease management of diabetes (HbA1c, LDL) and coronary artery disease (LDL), preventive breast, cervical, and colorectal cancer screening, and resource utilization measures including emergency department (ED) visits, hospitalizations, high-cost imaging, and patient-reported health experience. KEY RESULTS: At baseline, there were significant differences in sociodemographic and clinical characteristics between resident and staff physician patients. Resident patients were less likely to achieve chronic disease and preventive cancer screening outcome measures including LDL at goal (adjusted OR [aOR] 0.77 [95% CI 0.65, 0.92]) for patients with coronary artery disease; HbA1c at goal (aOR 0.73 [95% CI 0.62, 0.85]) for patients with diabetes; breast (aOR 0.56 [95% CI 0.49, 0.63]), cervical (aOR 0.66 [95% CI 0.60, 0.74]), and colorectal (aOR 0.72 [95% CI 0.65, 0.79] cancer screening. Additionally, resident patients had higher rates of ED visits and hospitalizations but lower rates of high-cost imaging. Resident patients reported lower rates of satisfaction with certain access to care and communication measures. Similar outcomes were noted in propensity-matched sensitivity analyses. CONCLUSION: After controlling for differences in sociodemographic and clinical factors, resident patients were less likely to achieve chronic disease and preventive cancer screening outcomes compared to staff patients. Further efforts to address ambulatory trainee education and primary care quality along with novel approaches to the management of the disproportionately disadvantaged resident patient panels are needed. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s11606-019-04960-5) contains supplementary material, which is available to authorized users. |
| Databáze: | OpenAIRE |
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