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A comparison of clinical performance of primary care and traditional internal medicine residents.

Abstract：

OBJECTIVE:To compare primary care and traditional Internal Medicine residents in their adherence to preventive medicine guidelines, performance in the management of chronic diseases, and utilization of resources. DESIGN:Prospective cohort study. SETTING:Urban Internal Medicine residency program. PARTICIPANTS:Sixteen primary care and 137 traditional Internal Medicine residents who took care of 6,307 patients (a total of 21,002 patient visits in a 1-year period). MEASUREMENTS:Adherence to preventive medicine guidelines for the screening of breast cancer, cervical cancer, hypercholesterolemia, and colon cancer; admission rates among patients with asthma, chronic pulmonary disease, and diabetes mellitus; four items in the management of diabetes; and resource utilization including the costs for laboratory and radiology tests and number of consultations. RESULTS:Primary care residents, as compared with traditional residents, adhered to preventive medicine guidelines for a greater proportion of their patients for the following: breast cancer among women aged 52 to 75 years (61% vs. 54%, respectively, P = 0.05); cholesterol screening among patients aged 20 to 64 years (39% vs. 33%, P = 0.007); colon cancer among patients older than 50 years (49% vs. 31%, P = 0.001); and cervical cancer among women aged 20 to 64 years (36% vs. 31%, P = 0.03). There were no differences in hospital admission rates for patients with diabetes or asthma. Total ambulatory care costs for tests, procedures, consults, and office visits were greater for patients of primary care residents ($1,045 vs. $899, P = 0.0001), although total costs per primary care visit were similar between the two patient groups. CONCLUSIONS:Primary care residents more closely adhered to preventive medicine guidelines but were similar to traditional residents in their management of chronic diseases. Patients of primary care residents had greater ambulatory care costs that were not entirely attributable to greater adherence to preventive medicine guidelines.

journal_name

Med Care

journal_title

Medical care

authors

Wong MD,Hollenberg JP,Charlson ME

doi

10.1097/00005650-199908000-00007

keywords:

subject

Has Abstract

pub_date

1999-08-01 00:00:00

pages

773-84

issue

eissn

0025-7079

issn

1537-1948

journal_volume

pub_type

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A comparison of clinical performance of primary care and traditional internal medicine residents.