Relationship between provider type and the attainment of treatment goals in primary care.
OBJECTIVE
To determine the relationship between provider type (eg, resident, mid-level practitioner, attending physician) and attainment of clinical goals with respect to the treatment of dyslipidemia, diabetes mellitus, and hypertension.


METHODS
Using electronic medical records, we identified all patients seen in the Veterans Affairs Connecticut Health Care System in a 6-month period with an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code corresponding to a diagnosis of coronary artery disease, diabetes mellitus, or hypertension.


METHODS
We recorded the most recent low-density lipoprotein cholesterol level for patients with diabetes or coronary artery disease, glycosylated hemoglobin level for patients with diabetes, and blood pressure for patients with hypertension. We then examined the relationship between these measures and provider type.


RESULTS
After controlling for patient age and practice site, no significant differences were noted between attending physicians and residents in attaining treatment goals for dyslipidemia (odds ratio [OR] 1.15, 95% confidence interval [CI] 0.96-1.38) or diabetes (OR 1.05, 95% CI 0.82-1.33). However, attending physicians were significantly more likely to attain blood pressure goals than were residents (59% vs 54%, P = .002; OR 1.23, 95% CI 1.08-1.39). Controlling for additional patient characteristics did not alter the findings.


CONCLUSIONS
Internal medicine residents may quickly develop expertise in managing dyslipidemia and diabetes mellitus. Residents in our sample, however, were less likely than attending physicians to reach goal blood pressure for patients with hypertension. Educational efforts aimed at house staff to improve the treatment of hypertension are warranted.
Federman
Daniel G
DG
VA Connecticut Health Care System, West Haven, Conncticut 06516, USA. daniel.federman@med.va.gov
Krishnamurthy
Raj
R
Kancir
Sue
S
Goulet
Joseph
J
Justice
Amy
A
D001794:Blood Pressure; D008078:Cholesterol, LDL / Q000097:blood; D003237:Connecticut; D003920:Diabetes Mellitus / Q000097:blood / Q000628:therapy; D006442:Glycated Hemoglobin / Q000032:analysis; D006282:Health Personnel / Q000145:classification*; D006801:Humans; D006949:Hyperlipidemias / Q000097:blood / Q000628:therapy; D006973:Hypertension / Q000503:physiopathology / Q000628:therapy; D009937:Organizational Objectives; D011320:Primary Health Care / Q000458:organization & administration*; D016896:Treatment Outcome; D014481:United States; D014493:United States Department of Veterans Affairs
D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin