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Presentation Description
Sean Hogan1
Kenji Yamazaki2, Steve Bandeian3 and Eric Holmboe1
1 Accreditation Council for Graduate Medical Education
2 Elevance Health, formerly Anthem
Kenji Yamazaki2, Steve Bandeian3 and Eric Holmboe1
1 Accreditation Council for Graduate Medical Education
2 Elevance Health, formerly Anthem
Background:
Upon graduating residency, Family Medicine (FM) and Internal Medicine (IM) physicians become responsible for coordinating care for patients with chronic diseases like type-2 diabetes (DM-2). The US Centers for Disease Control and Prevention recommends biannual HbA1c tests and yearly screening for retinopathy, and nephropathy for DM-2 patients[1]. The extent to which recent graduates adhere to clinical guidelines is unknown. By observing graduates in early unsupervised practice, we advance knowledge that quality measures can give programs feedback about residents’ disease management[2].
Upon graduating residency, Family Medicine (FM) and Internal Medicine (IM) physicians become responsible for coordinating care for patients with chronic diseases like type-2 diabetes (DM-2). The US Centers for Disease Control and Prevention recommends biannual HbA1c tests and yearly screening for retinopathy, and nephropathy for DM-2 patients[1]. The extent to which recent graduates adhere to clinical guidelines is unknown. By observing graduates in early unsupervised practice, we advance knowledge that quality measures can give programs feedback about residents’ disease management[2].
Summary of work:
We report guideline adherence for patients of recent residency graduates. We identified physicians who graduated residency in 2016. We use a private claims database to determine the percentage of DM-2 patients who received tests for HbA1c, nephropathy, and retinal function in 2017. Our database includes the US’ largest provider network, insuring ~1/3 Americans. Responsibility for these care processes was attributed to the physician who provided the plurality of outpatient evaluation visits.[3] Physicians who saw ≥5 DM-2 patients are included.
We report guideline adherence for patients of recent residency graduates. We identified physicians who graduated residency in 2016. We use a private claims database to determine the percentage of DM-2 patients who received tests for HbA1c, nephropathy, and retinal function in 2017. Our database includes the US’ largest provider network, insuring ~1/3 Americans. Responsibility for these care processes was attributed to the physician who provided the plurality of outpatient evaluation visits.[3] Physicians who saw ≥5 DM-2 patients are included.
Results:
Of 3887 recent IM and FM graduates, 1966 saw ≥5 DM-2 patients (range 5-266 patients/physician) aged 18-75. For Hba1C: 18% of recent graduates screened 100% of their DM-2 patients, and 83% of doctors screened ≥50% of patients, ~5% screened none. Nephropathy: only 11% of doctors screened all patients and 88% screened ≥50% of patients, and <1% screened none. Retinopathy: only 0.1% of doctors screened all patients and 15% of doctors screened ≥50% of patients, and 5% screened none.
Of 3887 recent IM and FM graduates, 1966 saw ≥5 DM-2 patients (range 5-266 patients/physician) aged 18-75. For Hba1C: 18% of recent graduates screened 100% of their DM-2 patients, and 83% of doctors screened ≥50% of patients, ~5% screened none. Nephropathy: only 11% of doctors screened all patients and 88% screened ≥50% of patients, and <1% screened none. Retinopathy: only 0.1% of doctors screened all patients and 15% of doctors screened ≥50% of patients, and 5% screened none.
Discussion:
Compliance with DM-2 screening guidelines varies substantially among patients of primary-care physicians who recently completed residency.
Compliance with DM-2 screening guidelines varies substantially among patients of primary-care physicians who recently completed residency.
Conclusions:
Residency programs may need to better prepare their graduates for chronic- disease management.
Residency programs may need to better prepare their graduates for chronic- disease management.
Implications for further research or practice:
Insurance claims reveal wide variation in recommended diabetes screenings for patients of recent residency graduates. Possible sources of variation require further study.
Insurance claims reveal wide variation in recommended diabetes screenings for patients of recent residency graduates. Possible sources of variation require further study.
References (maximum three)
1. https://www.cdc.gov/diabetes/managing/care-schedule.html
2. Kim JG, et al. The reliability of graduate medical education quality of care clinical performance measures. J Grad Med Educ. 2022 Jun;14(3):281-288. doi: 10.4300/JGME-D-21- 00706.1. Epub 2022 Jun 13. PMID: 35754636; PMCID: PMC9200256.
3. Nyweide DJ, et al. Relationship of primary care physicians' patient caseload with measurement of quality and cost performance. JAMA. 2009 Dec 9;302(22):2444-50. doi: 10.1001/jama.2009.1810. PMID: 19996399; PMCID: PMC2811529
2. Kim JG, et al. The reliability of graduate medical education quality of care clinical performance measures. J Grad Med Educ. 2022 Jun;14(3):281-288. doi: 10.4300/JGME-D-21- 00706.1. Epub 2022 Jun 13. PMID: 35754636; PMCID: PMC9200256.
3. Nyweide DJ, et al. Relationship of primary care physicians' patient caseload with measurement of quality and cost performance. JAMA. 2009 Dec 9;302(22):2444-50. doi: 10.1001/jama.2009.1810. PMID: 19996399; PMCID: PMC2811529