J Clin Outcomes Manage
Quality of diabetes care in a primary care teaching practice: how do resident physicians measure up?
Dushay J, Stjernfeldt KK, Kriegel G, Tadesse T, Phillips RS, Davis RB, Weingart SN
Abstract Objectives: To compare the quality of diabetes care provided by resident physicians versus faculty physicians and examine its concordance with published guidelines, and to investigate factors associated with management of glycemia and cardiovascular risk. Design: Retrospective cohort study. Patients and setting: 401 faculty patients and 98 resident patients with diabetes mellitus seen for an office visit between January 2001 and December 2002 at an academic primary care practice affiliated with a tertiary care medical center. Measurements: Diabetes and cardiovascular risk management by resident and faculty physicians, including measurement of hemoglobin A1c, serum lipids, blood pressure, and microalbuminuria, compared with published guidelines and benchmarks. Results: Faculty physician patients were older (mean age, 59.0 ± 14.3 vs. 55.6 ± 12.8 years; P = 0.03) and had more medical problems (9.9 ± 5.7 vs. 8.5 ± 5.1; P = 0.03) than resident patients but were otherwise comparable. There was no significant difference between faculty and resident patients in mean hemoglobin A1c (7.9% ± 1.8% vs. 8.2% ± 2.3%; P = 0.51), mean low-density lipoprotein (106 ± 38 vs. 103 ± 42 mg/dL; P = 0.38), or mean systolic blood pressure (132 ± 14.8 vs. 132 ± 15.9 mm Hg; P = 0.86). Faculty and residents monitored hemoglobin A1c (96% vs. 97%; P = 0.67), lipids (87% vs. 83%; P = 0.29), blood pressure (100% for both faculty and residents), and urine for microalbumin (65% vs. 72%; P = 0.18) with similar frequency, and rates of achieving lipid and blood pressure targets were equivalent. Conclusion: Resident physicians can provide diabetes care that is comparable to faculty physicians’ performance relative to established national guidelines and metrics.
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