دورية أكاديمية
أعرض في EDS

An Analysis of Trainee Status of the Primary Care Physician and Ambulatory Care Outcomes.

التفاصيل البيبلوغرافية
العنوان: An Analysis of Trainee Status of the Primary Care Physician and Ambulatory Care Outcomes.
المؤلفون: Graham KL, Norian E, Li J, Amat M, Davis RB
المصدر: Academic medicine : journal of the Association of American Medical Colleges [Acad Med] 2024 Jul 01; Vol. 99 (7), pp. 750-755. Date of Electronic Publication: 2024 Feb 14.
نوع المنشور: Journal Article
اللغة: English
بيانات الدورية: Publisher: Published for the Association of American Medical Colleges by Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 8904605 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1938-808X (Electronic) Linking ISSN: 10402446 NLM ISO Abbreviation: Acad Med Subsets: MEDLINE
أسماء مطبوعة: Publication: Philadelphia, PA : Published for the Association of American Medical Colleges by Lippincott Williams & Wilkins
Original Publication: [Philadelphia, Pa. : Hanley & Belfus, c1989-
مواضيع طبية MeSH: Ambulatory Care*/statistics & numerical data , Physicians, Primary Care*/statistics & numerical data , Physicians, Primary Care*/education, Humans ; Female ; Male ; Middle Aged ; Adult ; Cohort Studies ; Faculty, Medical/statistics & numerical data ; Internal Medicine/education ; Internal Medicine/statistics & numerical data ; Internship and Residency/statistics & numerical data ; Social Determinants of Health/statistics & numerical data ; Primary Health Care/statistics & numerical data ; Academic Medical Centers/statistics & numerical data ; Aged ; Healthcare Disparities/statistics & numerical data
مستخلص: Purpose: Prior studies report disparities in outcomes for patients cared for by trainees versus faculty physicians at academic medical centers. This study examined the effect of having a trainee as the primary care physician versus a faculty member on routine population health outcomes after adjusting for differences in social determinants of health and primary care retention.
Method: This cohort study assessed 38,404 patients receiving primary care at an academic hospital-affiliated practice by 60 faculty and 110 internal medicine trainees during academic year 2019. The effect of primary care practitioner trainee status on routine ambulatory care metrics was modeled using log-binomial regression with generalized estimating equation methods to account for physician-level clustering. Risk estimates before and after adjusting for social determinants of health and loss to follow-up are presented.
Results: Trainee and faculty cohorts had similar distributions of acute illness burden; however, patients in the trainee cohort were significantly more likely to identify as a race other than White (2,476 [52.6%] vs 14,785 [38.5%], P < .001), live in a zip code associated with poverty (1,688 [35.9%] vs 9,122 [23.8%], P < .001), use public health insurance (1,021 [21.7%] vs 6,108 [15.9%], P < .001), and have limited English proficiency (1,415 [30.1%] vs 5,203 [13.6%], P < .001). In adjusted analyses, trainee status of primary care physician was not associated with lack of breast cancer screening but was associated with missed opportunities to screen for colorectal cancer (relative risk [RR], 0.77; 95% confidence interval [CI], 0.68-0.88), control type 2 diabetes mellitus (RR, 0.78; 95% CI, 0.64-0.94), and control hypertension (RR, 0.80; 95% CI, 0.69-0.94).
Conclusions: Primary care physician trainee status was associated with poorer quality of care in the ambulatory setting after adjusting for differences in socioeconomic factors and loss to follow-up, highlighting a potential ambulatory training gap.
(Copyright © 2024 the Association of American Medical Colleges.)
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تواريخ الأحداث: Date Created: 20240215 Date Completed: 20240626 Latest Revision: 20240626
رمز التحديث: 20240626
DOI: 10.1097/ACM.0000000000005663
PMID: 38358939
قاعدة البيانات: MEDLINE
الوصف
تدمد:1938-808X
DOI:10.1097/ACM.0000000000005663