title: Variation in internal medicine residency clinic practices: assessing practice environments and quality of care.
abstract: BACKGROUND
  Few studies have systematically and rigorously examined the quality of care provided in educational practice sites.
  
  
  OBJECTIVE
  The objectives of this study were to (1) describe the patient population cared for by trainees in internal medicine residency clinics; (2) assess the quality of preventive cardiology care provided to these patients; (3) characterize the practice-based systems that currently exist in internal medicine residency clinics; and (4) examine the relationships between quality, practice-based systems, and features of the program: size, type of program, and presence of an electronic medical record.
  
  
  METHODS
  This is a cross-sectional observational study.
  
  
  METHODS
  This study was conducted in 15 Internal Medicine residency programs (23 sites) throughout the USA.
  
  
  METHODS
  The participants included site champions at residency programs and 709 residents.
  
  
  METHODS
  Abstracted charts provided data about patient demographics, coronary heart disease risk factors, processes of care, and clinical outcomes. Patients completed surveys regarding satisfaction. Site teams completed a practice systems survey.
  
  
  RESULTS
  Chart abstraction of 4,783 patients showed substantial variability across sites. On average, patients had between 3 and 4 of the 9 potential risk factors for coronary heart disease, and approximately 21% had at least 1 important barrier of care. Patients received an average of 57% (range, 30-77%) of the appropriate interventions. Reported satisfaction with care was high. Sites with an electronic medical record showed better overall information management (81% vs 27%) and better modes of communication (79% vs 43%).
  
  
  CONCLUSIONS
  This study has provided insight into the current state of practice in residency sites including aspects of the practice environment and quality of preventive cardiology care delivered. Substantial heterogeneity among the training sites exists. Continuous measurement of the quality of care provided and a better understanding of the training environment in which this care is delivered are important goals for delivering high quality patient care.
authors.affiliation: University of Miami, Coral Gables, FL, USA.
authors.forename: Jeanette
authors.initials: J
authors.lastname: Mladenovic
authors.forename: Judy A
authors.initials: JA
authors.lastname: Shea
authors.forename: F Daniel
authors.initials: FD
authors.lastname: Duffy
authors.forename: Lorna A
authors.initials: LA
authors.lastname: Lynn
authors.forename: Eric S
authors.initials: ES
authors.lastname: Holmboe
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Lipner
mesh_terms: D000328:Adult; D000368:Aged; D000554:Ambulatory Care Facilities; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000628:therapy; D002983:Clinical Competence; D003625:Data Collection; D005260:Female; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D017060:Patient Satisfaction; D010818:Practice Patterns, Physicians'; D011787:Quality of Health Care; D012307:Risk Factors; D012959:Socioeconomic Factors