Philadelphia, June 16, 2025 — Hospitalized patients treated by physicians who demonstrated more medical knowledge and judgment through higher scores on ABIM’s continuous knowledge assessment, known as the Longitudinal Knowledge Assessment (LKA®), were less likely to die within seven days of admission or be readmitted within seven days of discharge, according to a study published today in JAMA Internal Medicine.
Researchers analyzed data from more than 4,000 hospitalists who participated in the LKA in 2022 and 2023, focusing on outcomes for more than 260,000 hospitalizations of Medicare fee-for-service patients aged 66 and older. Scores from their first year of participation in the LKA were compared to the outcomes of their patients seen in the two years prior to participation in the LKA, specifically looking at seven-day mortality and seven-day readmissions.
The study found that physicians scoring in the top 25% of the quarterly LKA Progress Report demonstrated an 8% lower seven-day patient mortality rate compared to those in the bottom 25% (a difference of 4.1 deaths per 1,000 hospitalizations).
The authors also found a 5% reduction in seven-day readmission rates for patients of physicians scoring in the top versus bottom 25% (a difference of 3.1 readmissions per 1,000 hospitalizations).
While not a primary outcome, a similar association was discovered for 30-day mortality where higher-scoring physicians showed lower mortality rates compared to lower scoring physicians.
The findings are consistent with multiple other studies that have demonstrated that patients whose doctors demonstrate more medical knowledge and judgment through certification and Maintenance of Certification (MOC) have a better prognosis on a host of outcomes patients care about, like mortality, cost, process and quality of care measures and physician state medical board disciplinary actions. Those previous findings have been associated with performance on the single day, long-form, point-in-time exams. This is the first study to assess the prognostic implications for patients whose doctors are using the continuous certification LKA platform.
“Our results underscore the validity of the continuous knowledge assessment performance feedback as a signal of care quality in terms of outcomes that patients care about,” said Bradley M. Gray, Ph.D., corresponding author, and Principal Health Services Researcher at ABIM.
Introduced by ABIM in 2022, the LKA is an alternative to the traditional, 10-year Maintenance of Certification (MOC) assessment. Physicians participating in the LKA complete up to 30 questions quarterly in an open-book format, receiving a summative pass/fail decision at the conclusion of a five-year cycle. Physicians also receive immediate feedback after answering a question, which helps them assess their clinical knowledge and identify areas for improvement. Starting early in the second year of participation, the quarterly LKA Progress Report is designed to identify gaps in knowledge that might impact patient care and to display trends in performance over time.
About ABIM
Internists and subspecialists who earn and maintain board certification from the American Board of Internal Medicine (ABIM) differentiate themselves every day through their specialized knowledge and commitment to continual learning in service of their patients. Established as an independent nonprofit more than 85 years ago, ABIM continues to be a vehicle by which the profession sets standards for itself, specifically doctors who want to achieve higher standards for better care in a rapidly changing world. Visit ABIM's blog to learn more and follow ABIM on LinkedIn, and Instagram. ABIM is a Member Board of the American Board of Medical Specialties.
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