Kelly L Graham, Elizabeth Norian, Jonathan Li, Maelys Amat, Roger B Davis
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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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":null,"pages":null},"PeriodicalIF":5.3000,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"An Analysis of Trainee Status of the Primary Care Physician and Ambulatory Care Outcomes.\",\"authors\":\"Kelly L Graham, Elizabeth Norian, Jonathan Li, Maelys Amat, Roger B Davis\",\"doi\":\"10.1097/ACM.0000000000005663\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>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.</p><p><strong>Method: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p>\",\"PeriodicalId\":50929,\"journal\":{\"name\":\"Academic Medicine\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":5.3000,\"publicationDate\":\"2024-07-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Academic Medicine\",\"FirstCategoryId\":\"95\",\"ListUrlMain\":\"https://doi.org/10.1097/ACM.0000000000005663\",\"RegionNum\":2,\"RegionCategory\":\"教育学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/2/14 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"EDUCATION, SCIENTIFIC DISCIPLINES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Academic Medicine","FirstCategoryId":"95","ListUrlMain":"https://doi.org/10.1097/ACM.0000000000005663","RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/2/14 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"EDUCATION, SCIENTIFIC DISCIPLINES","Score":null,"Total":0}
引用次数: 0
摘要
目的:先前的研究报告显示,在学术医疗中心,受训医师与教职医师对患者的治疗效果存在差异。本研究在调整了健康的社会决定因素和初级保健保留率的差异后,考察了由受训人员担任初级保健医生与由教职员工担任初级保健医生对常规人群健康结果的影响:这项队列研究对2019学年在一家学术医院附属诊所接受初级保健的38404名患者进行了评估,其中包括60名教职员工和110名内科受训人员。采用对数二项式回归法和广义估计方程法建立模型,以考虑医生层面的聚类,从而得出全科医生受训人员身份对常规门诊护理指标的影响。结果显示了调整社会健康决定因素和随访损失前后的风险估计值:受训人员队列和教职员队列的急性病负担分布相似;但是,受训人员队列中的患者更有可能被认定为白人以外的种族(2,476 [52.6%] vs 14,785 [38.5%],P < .001)、居住在与贫困相关的邮政编码内(1,688 [35.9%] vs 9,122 [23.8%],P < .001)、使用公共医疗保险(1,021 [21.7%] vs 6,108 [15.9%],P < .001)和英语水平有限(1,415 [30.1%] vs 5,203 [13.6%],P < .001)。在调整后的分析中,初级保健医生的实习生身份与未进行乳腺癌筛查无关,但与错过筛查大肠癌(相对风险 [RR],0.77;95% CI,0.68-0.88)、控制 2 型糖尿病(RR,0.78;95% CI,0.64-0.94)和控制高血压(RR,0.80;95% CI,0.69-0.94)的机会有关:在调整了社会经济因素和随访损失的差异后,初级保健医生受训者身份与较差的门诊护理质量有关,这凸显了潜在的门诊培训差距。
An Analysis of Trainee Status of the Primary Care Physician and Ambulatory Care Outcomes.
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.
期刊介绍:
Academic Medicine, the official peer-reviewed journal of the Association of American Medical Colleges, acts as an international forum for exchanging ideas, information, and strategies to address the significant challenges in academic medicine. The journal covers areas such as research, education, clinical care, community collaboration, and leadership, with a commitment to serving the public interest.