Journal of General Internal Medicine

, Volume 25, Issue 11, pp 1193–1197 | Cite as

Quality of US Primary Care Delivered by Resident and Staff Physicians

Original Research

ABSTRACT

Background

Few population-based data are available on the quality of outpatient care provided by resident physicians in the US.

Objective

To assess the quality of outpatient care delivered by resident and staff physicians.

Design

Cross-sectional analysis. We used chi-square tests to compare resident and staff physician performance on 19 quality indicators. Using multivariable logistic regression, we controlled for sex, age, race/ethnicity, insurance, and metropolitan status.

Participants

33,900 hospital-based outpatient visits from the 1997-2004 National Hospital Ambulatory Medical Care Survey (NHAMCS).

Measurements

Resident and staff physician performance on 19 quality indicators.

Results

Resident physicians were more likely to care for younger, non-white, female, urban, and Medicaid-insured patients. In both adjusted and unadjusted analyses, residents outperformed staff on four of 19 measures including angiotensin converting enzyme inhibitor use for congestive heart failure (57.0% vs. 27.6%; p = <0.001), diuretic use for hypertension (57.8% vs. 44.0%; p = <0.001), statin use for hyperlipidemia (56.3% vs. 40.4%; p = 0.001), and routine blood pressure screening (85.3% vs. 79.6%; p = 0.02). Residents and staff performed at similar levels for counseling (range 15.7 to 32.0%). Residents and staff performed similarly well on measures capturing inappropriate prescribing or overuse of diagnostic testing (range 48.6 to 100%). Residents and staff performed similarly on measures of appropriate prescribing (range from 30.9% to 69.2%).

Conclusions

Primary care provided by resident physicians is of similar or higher quality than that provided by staff physicians. Significant opportunity remains to improve quality of outpatient care provided by all physicians. Residency training programs should devote attention to improving outpatient quality of care delivered by residents.

KEY WORDS

resident quality of care primary care 

Abbreviations

ACE

angiotensin converting enzyme

BB

beta blocker

CAD

coronary artery disease

CBC

complete blood count

CHF

chronic heart failure

ECG

electrocardiography

HTN

hypertension

IC

inhaled corticosteroid

TMP SMX

trimethoprim sulfamethoxazole

URTI

upper respiratory tract infection

UTI

urinary tract infection

Notes

Acknowledgements

We thank Dr Stephanie Woolhandler for her editorial comments, and Meredith Manze for her assistance with manuscript preparation.

Conflict of Interest

There are no financial conflicts of interest for any of the authors.

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Copyright information

© Society of General Internal Medicine 2010

Authors and Affiliations

  • Leah Zallman
    • 1
  • Jun Ma
    • 2
  • Lan Xiao
    • 2
  • Karen E. Lasser
    • 3
  1. 1.Department of Medicine, Cambridge Health Alliance and Harvard Medical SchoolCambridgeUSA
  2. 2.Palo Alto Medical Foundation Research InstitutePalo AltoUSA
  3. 3.Section of General Internal MedicineBoston Medical CenterBostonUSA

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