title: Relationship between provider type and the attainment of treatment goals in primary care.
abstract: 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.
authors.affiliation: VA Connecticut Health Care System, West Haven, Conncticut 06516, USA. daniel.federman@med.va.gov
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Federman
authors.forename: Raj
authors.initials: R
authors.lastname: Krishnamurthy
authors.forename: Sue
authors.initials: S
authors.lastname: Kancir
authors.forename: Joseph
authors.initials: J
authors.lastname: Goulet
authors.forename: Amy
authors.initials: A
authors.lastname: Justice
mesh_terms: 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
chemical_list: D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin