The quality of care that resident physicians in the U.S. provide could be subjected only in a limited way to research for the lack of a comparison group.
Now, in order to gain insight on differences in quality of care provided by resident physicians versus staff physicians, Boston Medical Center (BMC) and Palo Alto Medical Foundation researchers investigated performance of physicians in 33,900 hospital-based outpatient visits throughout the US.
The researchers collected data from the 1997-2004 National Hospital Ambulatory Medical Care Survey and separated patient visits to resident and staff physicians. To monitor performance in multiple areas of common primary care they created 19 quality indicators that fell into five categories: medical management of chronic diseases; appropriate antibiotic use; preventative counseling; screening tests; and inappropriate prescribing in elderly patients. Performance quality was calculated as the percentage of eligible visits that received recommended care as defined in practice guidelines and consensus expert statements. Statistical analyses were performed after the mean performance rates of staff and residents were calculated for each quality indicator.
"This study highlights the significant opportunity that remains to improve quality of outpatient care in the United States," said author Karen E. Lasser, MD, MPH, an associate professor of medicine at BUSM and staff physician at BMC. "Quality improvement interventions that address specific barriers at the system, provider, and patient level are necessary in order to reduce the discrepancy between clinical practice and best evidence." These findings appear in the Journal of General Internal Medicine online.