Inpatient-outpatient Transitions for Patients with Resident Primary Care Physicians: Access and Readmission

Doctoroff, Lauren; McNally, Diane; Vanka, Anita; Nall, Ryan; Mukamal, Kenneth J.

doi:10.1016/j.amjmed.2014.03.038

Cited by 16 publications

(11 citation statements)

References 29 publications

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“…In a more recent analysis that evaluated inpatient to outpatient transitions of resident patients compared to staff patients, Doctoroff et al found that resident patients had lower rates of timely post-discharge follow-up than staff physicians. 44 However, these data were limited to patients who were recently hospitalized and did not examine preventive care outcomes.…”

Section: Discussionmentioning

confidence: 99%

Disparities in Quality of Primary Care by Resident and Staff Physicians: Is There a Conflict Between Training and Equity?

Essien

Ray

et al. 2019

J GEN INTERN MED

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BACKGROUND: Outpatient primary care experience is vital to internal medicine resident training but may impact quality and equity of care delivered in practices that include resident physicians. Understanding whether quality differences exist among resident and staff primary care physicians (PCPs) may present an opportunity to address health disparities within academic medical centers. OBJECTIVE: To determine whether there are differences in the quality of primary care provided by resident PCPs compared to staff PCPs. DESIGN: A retrospective cohort study with a propensitymatched analysis. PARTICIPANTS: 143,274 patients, including 10,870 patients managed by resident PCPs, seen in 16 primary care practices affiliated with an academic medical center. MAIN MEASURES: Guideline-concordant chronic disease management of diabetes (HbA1c, LDL) and coronary artery disease (LDL), preventive breast, cervical, and colorectal cancer screening, and resource utilization measures including emergency department (ED) visits, hospitalizations, high-cost imaging, and patient-reported health experience. KEY RESULTS: At baseline, there were significant differences in sociodemographic and clinical characteristics between resident and staff physician patients. Resident patients were less likely to achieve chronic disease and preventive cancer screening outcome measures including LDL at goal (adjusted OR [aOR] 0.77 [95% CI 0.65, 0.92]) for patients with coronary artery disease; HbA1c at goal (aOR 0.73 [95% CI 0.62, 0.85]) for patients with diabetes; breast (aOR 0.56 [95% CI 0.49, 0.63]), cervical (aOR 0.66 [95% CI 0.60, 0.74]), and colorectal (aOR 0.72 [95% CI 0.65, 0.79] cancer screening. Additionally, resident patients had higher rates of ED visits and hospitalizations but lower rates of high-cost imaging. Resident patients reported lower rates of satisfaction with certain access to care and communication measures. Similar outcomes were noted in propensity-matched sensitivity analyses.CONCLUSION: After controlling for differences in sociodemographic and clinical factors, resident patients were less likely to achieve chronic disease and preventive cancer screening outcomes compared to staff patients. Further efforts to address ambulatory trainee education and primary care quality along with novel approaches to the management of the disproportionately disadvantaged resident patient panels are needed.

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Section: Discussionmentioning

confidence: 99%

Disparities in Quality of Primary Care by Resident and Staff Physicians: Is There a Conflict Between Training and Equity?

Essien

Ray

et al. 2019

J GEN INTERN MED

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“…1,2,22–25 Multiple studies have indicated the need for further investigation of patient-centered interventions to improve transitions of care. 17–19 In a qualitative study of patients with HF from lower socioeconomic strata (73% living at poverty level or lower), Riegel and colleagues found that identifying patient barriers and ways of overcoming barriers were crucial steps in achieving adherence and better outcomes.…”

Section: Discussionmentioning

confidence: 99%

Patient Perceptions on Facilitating Follow-Up After Heart Failure Hospitalization

Breathett

Damico

Adesanya

et al. 2017

Circ: Heart Failure

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Background Timely follow-up after hospitalization for heart failure (HF) is recommended. However, follow-up is suboptimal, especially in lower socioeconomic groups. Patient-centered solutions for facilitating follow-up post HF hospitalization have not been extensively evaluated. Methods and Results Face-to-face surveys were conducted between 2015 and 2016 among 83 racially diverse adult patients (61% African-American, 34% Caucasian, 5% Other) hospitalized for HF at a university hospital centered in a low-income area of Columbus, Ohio. Patient perceptions of methods to facilitate follow-up post HF hospitalization and likelihood of using interventions were investigated using a Likert scale: 1=very much to 5=not at all. Results were analyzed by Wilcoxon signed rank test with Bonferroni correction. The response rate was 82%. The annual household income was <$35,000 for 49% of patients. An appointment near the patient’s home was the most desired intervention (77%), followed by reminder message (73%), transportation to appointment (63%), and elimination of co-payment (59%). Interventions most likely to be used if provided were similarly ranked: reminder message (48%), appointment near home (46%), elimination of co-pay (46%), and transportation to appointment (39%). There were significant differences (p=0.001) in high-ranking interventions related to location (appointment near home, transportation, home appointment) and reminder for visit compared to low-ranking interventions related to time (weekend appointment, appointment after 5pm) and telemedicine. Conclusions Among this cohort of racially diverse low-income patients hospitalized with HF, an appointment near the patient’s home and a reminder message were the most desired interventions to facilitate follow-up. Further study of similar populations nationwide is warranted.

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“…Of the 6 articles focusing on ambulatory handoffs, only 3 implemented standardized documentation processes, [40][41][42] and no changes in patient-level outcomes were noted. Doctoroff et al 43 found that residents' patients have lessrobust outpatient follow-up after hospitalization as compared with patients with faculty primary care physicians (PCPs). Two of the 49 studies described hospital follow-up visit programs in residency clinics.…”

Section: Clinic Redesignmentioning

confidence: 99%

“…52 Multiple studies identified disparities in the care of patients with resident PCPs (versus faculty PCPs), in areas such as diabetes care, cancer screening, discharge follow-up, and readmission rates. 43,[57][58][59][60][61][62] Given those disparities, further research is needed in assessing resident competence via EPAs and in determining what factors predict worse outcomes in patients seen by residents to identify areas for intervention and find the balance between autonomy and supervision.…”

Section: Evaluating Resident Practice and Performancementioning

confidence: 99%

A Decade of Teaching and Learning in Internal Medicine Ambulatory Education: A Scoping Review

Coyle

Helenius

Cruz

et al. 2019

Journal of Graduate Medical Education

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Background Ambulatory training in internal medicine residency programs has historically been considered less robust than inpatient-focused training, which prompted a 2009 revision of the Accreditation Council for Graduate Medical Education (ACGME) Program Requirements in Internal Medicine. This revision was intended to create a balance between inpatient and outpatient training standards and to spur innovation in the ambulatory setting. Objective We explored innovations in ambulatory education in internal medicine residency programs since the 2009 revision of the ACGME Program Requirements in Internal Medicine. Methods The authors conducted a scoping review of the literature from 2008 to 2017, searching PubMed, ERIC, and Scopus databases. Articles related to improving educational quality of ambulatory components of US-based internal medicine residency programs were eligible for inclusion. Articles were screened for relevance and theme categorization and then divided into 6 themes: clinic redesign, curriculum development, evaluating resident practice/performance, teaching methods, program evaluation, and faculty development. Once a theme was assigned, data extraction and quality assessment using the Medical Education Research Study Quality Instrument (MERSQI) score were completed. Results A total of 967 potentially relevant articles were discovered; of those, 182 were deemed relevant and underwent full review. Most articles fell into curriculum development and clinic redesign themes. The majority of included studies were from a single institution, used nonstandardized tools, and assessed outcomes at the satisfaction or knowledge/attitude/skills levels. Few studies showed behavioral changes or patient-level outcomes. Conclusions While a rich diversity of educational innovations have occurred since the 2009 revision of the ACGME Program Requirements in Internal Medicine, there is a significant need for multi-institution studies and higher-level assessment.

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Inpatient-outpatient Transitions for Patients with Resident Primary Care Physicians: Access and Readmission

Cited by 16 publications

References 29 publications

Disparities in Quality of Primary Care by Resident and Staff Physicians: Is There a Conflict Between Training and Equity?

Disparities in Quality of Primary Care by Resident and Staff Physicians: Is There a Conflict Between Training and Equity?

Patient Perceptions on Facilitating Follow-Up After Heart Failure Hospitalization

A Decade of Teaching and Learning in Internal Medicine Ambulatory Education: A Scoping Review

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