A comparison of clinical performance of primary care and traditional internal medicine residents.
OBJECTIVE
To compare primary care and traditional Internal Medicine residents in their adherence to preventive medicine guidelines, performance in the management of chronic diseases, and utilization of resources.


METHODS
Prospective cohort study.


METHODS
Urban Internal Medicine residency program.


METHODS
Sixteen primary care and 137 traditional Internal Medicine residents who took care of 6,307 patients (a total of 21,002 patient visits in a 1-year period).


METHODS
Adherence to preventive medicine guidelines for the screening of breast cancer, cervical cancer, hypercholesterolemia, and colon cancer; admission rates among patients with asthma, chronic pulmonary disease, and diabetes mellitus; four items in the management of diabetes; and resource utilization including the costs for laboratory and radiology tests and number of consultations.


RESULTS
Primary care residents, as compared with traditional residents, adhered to preventive medicine guidelines for a greater proportion of their patients for the following: breast cancer among women aged 52 to 75 years (61% vs. 54%, respectively, P = 0.05); cholesterol screening among patients aged 20 to 64 years (39% vs. 33%, P = 0.007); colon cancer among patients older than 50 years (49% vs. 31%, P = 0.001); and cervical cancer among women aged 20 to 64 years (36% vs. 31%, P = 0.03). There were no differences in hospital admission rates for patients with diabetes or asthma. Total ambulatory care costs for tests, procedures, consults, and office visits were greater for patients of primary care residents ($1,045 vs. $899, P = 0.0001), although total costs per primary care visit were similar between the two patient groups.


CONCLUSIONS
Primary care residents more closely adhered to preventive medicine guidelines but were similar to traditional residents in their management of chronic diseases. Patients of primary care residents had greater ambulatory care costs that were not entirely attributable to greater adherence to preventive medicine guidelines.
Wong
M D
MD
University of California at Los Angeles School of Medicine, Division of General Internal Medicine and Health Services Research, 90095-1736, USA. mdwong@ucla.edu
Hollenberg
J P
JP
Charlson
M E
ME
D000046:Academic Medical Centers / Q000592:standards / Q000706:statistics & numerical data; D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000592:standards / Q000706:statistics & numerical data; D016009:Chi-Square Distribution; D002983:Clinical Competence / Q000706:statistics & numerical data*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007388:Internal Medicine / Q000592:standards* / Q000706:statistics & numerical data; D007396:Internship and Residency / Q000592:standards* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009519:New York City; D017063:Outcome Assessment, Health Care / Q000592:standards / Q000706:statistics & numerical data; D011314:Preventive Health Services / Q000592:standards / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000592:standards* / Q000706:statistics & numerical data; D011446:Prospective Studies; D012044:Regression Analysis; D000078329:Workforce