Association between maintenance of certification examination scores and quality of care for medicare beneficiaries.

Full Abstract

BACKGROUND:
The relationship between physicians' cognitive skill and the delivery of evidence-based processes of care is not well characterized.Therefore, we set out to determine associations between general internists' performance on the American Board of Internal Medicine maintenance of certification examination and the receipt of important processes of care by Medicare patients.

METHODS:
Physicians were grouped into quartiles based on their performance on the American Board of Internal Medicine examination. Hierarchical generalized linear models examined associations between examination scores and the receipt of processes of care by Medicare patients. The main outcome measures were the associations between diabetes care, using a composite measure of hemoglobin A(1c), and lipid testing and retinal screening, mammography, and lipid testing in patients with cardiovascular disease and the physician's performance on the American Board of Internal Medicine examination, adjusted for the number of Medicare patients with diabetes and cardiovascular disease in a physician's practice panel; frequency of visits; patient comorbidity, age, and ethnicity; and physician training history and type of practice.

RESULTS:
Physicians scoring in the top quartile were more likely to perform processes of care for diabetes (composite measure odds ratio [OR], 1.17; 95% confidence interval [CI], 1.07-1.27) and mammography screening (OR, 1.14; 95% CI, 1.08-1.21) than physicians in the lowest physician quartile, even after adjustment for multiple factors. There was no significant difference among the groups in lipid testing of patients with cardiovascular disease (OR, 1.00; 95% CI, 0.91-1.10).

CONCLUSION:
Our findings suggest that physician cognitive skills, as measured by a maintenance of certification examination, are associated with higher rates of processes of care for Medicare patients.

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Author information

Author/s: Holmboe, Eric S (ES); Wang, Yun (Y); Meehan, Thomas P (TP); Tate, Janet P (JP); Ho, Shih-Yieh (SY); Starkey, Katie S (KS); Lipner, Rebecca S (RS);

Affiliation: American Board of Internal Medicine, 510 Walnut St, Ste 1700, Philadelphia, PA 19106, USA. eholmboe(-atsign-)abim.org

Journal and publication information

Publication Type: Journal Article; Research Support, Non-U.S. Gov't

Journal: Archives of internal medicine (Arch Intern Med), published in United States. (Language: eng)

Reference: 2008-Jul; vol 168 (issue 13) : pp 1396-403

Dates: Created 2008/07/15; Completed 2008/08/06;

PMID: 18625919, status: MEDLINE (last retrieval date: 11/6/2008)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

Comments and Corrections

CommentIn: Arch Intern Med. 2008 Jul 14;168(13):1365-7. (PMID: 18625915)

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Attitude of Health Personnel
Certification
Clinical Competence
Confidence Intervals
Education, Medical, Continuing - standards; trends
Female
Health Care Surveys
Humans
Internal Medicine - education; standards
Linear Models

Male
Medicare
Multivariate Analysis
Physician's Practice Patterns - standards; trends
Primary Health Care - standards; trends
Probability
Quality of Health Care
Registries
Task Performance and Analysis
United States

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