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Variation in Internal Medicine Residency Clinic Practices: Assessing Practice Environments and Quality of Care

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Abstract

Background

Few studies have systematically and rigorously examined the quality of care provided in educational practice sites.

Objective

The objectives of this study were to (1) describe the patient population cared for by trainees in internal medicine residency clinics; (2) assess the quality of preventive cardiology care provided to these patients; (3) characterize the practice-based systems that currently exist in internal medicine residency clinics; and (4) examine the relationships between quality, practice-based systems, and features of the program: size, type of program, and presence of an electronic medical record.

Design

This is a cross-sectional observational study.

Setting

This study was conducted in 15 Internal Medicine residency programs (23 sites) throughout the USA.

Participants

The participants included site champions at residency programs and 709 residents.

Measurements

Abstracted charts provided data about patient demographics, coronary heart disease risk factors, processes of care, and clinical outcomes. Patients completed surveys regarding satisfaction. Site teams completed a practice systems survey.

Results

Chart abstraction of 4,783 patients showed substantial variability across sites. On average, patients had between 3 and 4 of the 9 potential risk factors for coronary heart disease, and approximately 21% had at least 1 important barrier of care. Patients received an average of 57% (range, 30–77%) of the appropriate interventions. Reported satisfaction with care was high. Sites with an electronic medical record showed better overall information management (81% vs 27%) and better modes of communication (79% vs 43%).

Conclusions

This study has provided insight into the current state of practice in residency sites including aspects of the practice environment and quality of preventive cardiology care delivered. Substantial heterogeneity among the training sites exists. Continuous measurement of the quality of care provided and a better understanding of the training environment in which this care is delivered are important goals for delivering high quality patient care.

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Acknowledgments

This work was supported by an American Board of Internal Medicine Foundation (ABIMF) grant but does not necessarily reflect the views of the ABIMF. The authors would like to acknowledge the Alliance for Academic Internal Medicine (AAIM) for their collaboration on this project. ABIMF paid AAIM $28,000 to support their work on the project.

Conflict of Interest Statement:

None disclosed.

Author information

Authors and Affiliations

  1. University of Miami, Coral Gables, FL, USA

    Jeanette Mladenovic MD

  2. University of Pennsylvania, Philadelphia, PA, USA

    Judy A. Shea PhD

  3. American Board of Internal Medicine, Philadelphia, PA, USA

    F. Daniel Duffy MD, Lorna A. Lynn MD, Eric S. Holmboe MD & Rebecca S. Lipner PhD

Authors
  1. Jeanette Mladenovic MD
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  2. Judy A. Shea PhD
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  3. F. Daniel Duffy MD
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  4. Lorna A. Lynn MD
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  5. Eric S. Holmboe MD
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  6. Rebecca S. Lipner PhD
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Corresponding author

Correspondence to Rebecca S. Lipner PhD.

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Mladenovic, J., Shea, J.A., Duffy, F.D. et al. Variation in Internal Medicine Residency Clinic Practices: Assessing Practice Environments and Quality of Care. J GEN INTERN MED 23, 914–920 (2008). https://doi.org/10.1007/s11606-008-0511-6

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  • DOI: https://doi.org/10.1007/s11606-008-0511-6

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