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- Title
Association Between Physician Time-Unlimited vs Time-Limited Internal Medicine Board Certification and Ambulatory Patient Care Quality.
- Authors
Hayes, John; Jackson, Jeffrey L.; McNutt, Gail M.; Hertz, Brian J.; Ryan, Jeffrey J.; Pawlikowski, Scott A.
- Abstract
IMPORTANCE American Board of Internal Medicine (ABIM) initiatives encourage internists with time-unlimited certificates to recertify. However, there are limited data evaluating differences in performance between internists with time-limited or time-unlimited board certification. OBJECTIVE To determine whether there are differences in primary care quality between physicians holding time-limited or time-unlimited certification. DESIGN, SETTING, AND PARTICIPANTS Retrospective analysis of performance data from 1 year (2012-2013) at 4 Veterans Affairs (VA) medical centers. Participants were internists with time-limited (n = 71) or time-unlimited (n = 34) ABIM certification providing primary care to 68 213 patients. Median physician panel size was 610 patients (range, 19-1316), with no differences between groups (P = .90). MAIN OUTCOMES AND MEASURES Ten primary care performance measures: colorectal screening rates: diabetes with glycated hemoglobin (HbA1c level) less than 9.0%; diabetes with blood pressure less than 140/90 mm Hg; diabetes with low-density lipoprotein cholesterol (LDL-C) level less than 100 mg/dL; hypertension with blood pressure less than 140/90 mm Hg; thiazide diuretics used in multidrug hypertensive regimen; atherosclerotic coronary artery disease and LDL-C level less than 100 mg/dL; post-myocardial infarction use of aspirin; post-myocardial infarction use of (3-blockers; congestive heart failure (CHF) with use of angiotensin-converting enzyme (ACE) inhibitor. RESULTS After adjustment for practice site, panel size, years since certification, and clustering by physician, there were no differences in outcomes for patients cared for by internists with time-limited or time-unlimited certification for any performance measure: colorectal screening (odds ratio [OR], 0.95 [95% Cl, 0.89-1.01]); diabetes with HbA1c level less than 9.0% (OR, 0.96 [95% Cl, 0.74-1.2]); blood pressure control (OR, 0.99 [95% Cl, 0.69-1.4]); LDL-C level less than 100 mg/dL (OR, 1.1 [95% Cl, 0.79-1.5]); hypertension with blood pressure less than 140/90 mm Hg (OR, 1.0 [95% Cl, 0.92-1.2]); thiazide use (OR, 1.0 [95% Cl, 0.8-1.3]); atherosclerotic coronary artery disease with LDL-C level less than 100 mg/dL (OR, 1.1 [95% Cl, 0.75-1.7]); post-myocardial infarction use of aspirin (OR, 0.98 [95% Cl, 0.58-1.68]) or fS-blocl<ers (OR, 1.0 [95% Cl, 0.57-1.9]); CHF with use of ACE inhibitor (OR, 0.98 [95% Cl, 0.61-1.6]). CONCLUSIONS and RELEVANCE Among internists providing primary care at 4 VA medical centers, there were no significant differences between those with time-limited ABIM certification and those with time-unlimited ABIM certification on 10 primary care performance measures. Additional research to examine the difference in patient outcomes among holders of time-limited and time-unlimited certificates in non-VA and nonacademic settings and the association with other ABIM goals may help clarify the potential benefit of Maintenance of Certification participation.
- Subjects
UNITED States; CERTIFICATION of physicians; AMERICAN Board of Internal Medicine (Organization); INTERNISTS; MEDICAL quality control; JOB performance
- Publication
JAMA: Journal of the American Medical Association, 2014, Vol 312, Issue 22, p2358
- ISSN
0098-7484
- Publication type
Article
- DOI
10.1001/jama.2014.13992