Arnold GK, Lipner RS, Weng W, Holmboe ES. — American Board of Internal Medicine
Presented: International Conference on Health Policy Statistics, January 2008
Abstract: The American Board of Internal Medicine’s Maintenance of Certification program includes an assessment of physicians' efforts to improve the quality of their patient care through a Web-based reporting system called the Practice Improvement Modules. Data collected from the Comprehensive Care (CC) PIM for this study included 190 primary care practice system questionnaires, 4,733 patient surveys, and 12,752 chart audits of diabetic and hypertensive patients. Exploratory factor analysis was used to identify systems composite scores and item weights. Standardized composite scores from systems questionnaires were used in k-means cluster model to identify two types of office practices: Care Coordination ECO (electronic coordination) versus Quality Improvement and Performance QIP systems of ambulatory care. Mixed linear were used to estimate practice level means for clinical values and patient ratings GEE models were used to estimate odds-ratios for quality performance and care process measures adjusted for patient factors and test for differences in practice systems. Evidence-based care hypothesis of better systems yield, better outcomes was only partially supported. The ECO group, most similar to the idealized office design and patient-centered care had better control of outcomes related to hypertensive care, but the QIP was better at achieving the diabetes hemoglobin control. No differences in patient ratings of physicians and practices quality were observed.
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