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Home Research Research Library The Effects of Training Institution Practice Costs, Quality, and Other Characteristics on Future Practice The Effects of Training Institution Practice Costs, Quality, and Other Characteristics on Future Practice 2017 Author(s) Phillips, Robert L, Petterson, Stephen M, Bazemore, Andrew W, Wingrove, Peter M, and Puffer, James C Topic(s) Education & Training Keyword(s) Imprinting Of Training Volume Annals of Family Medicine Source Annals of Family Medicine PURPOSE: Medicare beneficiary spending patterns reflect those of the 306 Hospital Referral Regions where physicians train, but whether this holds true for smaller areas or for quality is uncertain. This study assesses whether cost and quality imprinting can be detected within the 3,436 Hospital Service Areas (HSAs), 82.4 percent of which have only 1 teaching hospital, and whether sponsoring institution characteristics are associated. METHODS: We conducted a secondary, multi-level, multivariable analysis of 2011 Medicare claims and American Medical Association Masterfile data for a random, nationally representative sample of family physicians and general internists who completed residency between 1992 and 2010 and had more than 40 Medicare patients (3,075 physicians providing care to 503,109 beneficiaries). Practice and training locations were matched with Dartmouth Atlas HSAs and categorized into low-, average-, and high-cost spending groups. Practice and training HSAs were assessed for differences in 4 diabetes quality measures. Institutional characteristics included training volume and percentage of graduates in rural practice and primary care. RESULTS: The unadjusted, annual, per-beneficiary spending difference between physicians trained in high- and low-cost HSAs was $1,644 (95% CI, $1,253-$2,034), and the difference remained significant after controlling for patient and physician characteristics. No significant relationship was found for diabetes quality measures. General internists were significantly more likely than family physicians to train in high-cost HSAs. Institutions with more graduates in rural practice and primary care produced lower-spending physicians. CONCLUSIONS: The “imprint” of training spending patterns on physicians is strong and enduring, without discernible quality effects, and, along with identified institutional features, supports measures and policy options for improved graduate medical education outcomes. ABFM Research Read all 2011 Variation over time in preventable hospitalization rates across counties Go to Variation over time in preventable hospitalization rates across counties 1992 1991 certification-recertification examinations Go to 1991 certification-recertification examinations 2017 Impact of Potential Accreditation and Certification in Family Medicine Maternity Care Go to Impact of Potential Accreditation and Certification in Family Medicine Maternity Care 2020 Family Medicine Clerkship Directors’ Handling of Student Mistreatment: Results From a CERA Survey Go to Family Medicine Clerkship Directors’ Handling of Student Mistreatment: Results From a CERA Survey
Author(s) Phillips, Robert L, Petterson, Stephen M, Bazemore, Andrew W, Wingrove, Peter M, and Puffer, James C Topic(s) Education & Training Keyword(s) Imprinting Of Training Volume Annals of Family Medicine Source Annals of Family Medicine
ABFM Research Read all 2011 Variation over time in preventable hospitalization rates across counties Go to Variation over time in preventable hospitalization rates across counties 1992 1991 certification-recertification examinations Go to 1991 certification-recertification examinations 2017 Impact of Potential Accreditation and Certification in Family Medicine Maternity Care Go to Impact of Potential Accreditation and Certification in Family Medicine Maternity Care 2020 Family Medicine Clerkship Directors’ Handling of Student Mistreatment: Results From a CERA Survey Go to Family Medicine Clerkship Directors’ Handling of Student Mistreatment: Results From a CERA Survey
2011 Variation over time in preventable hospitalization rates across counties Go to Variation over time in preventable hospitalization rates across counties
1992 1991 certification-recertification examinations Go to 1991 certification-recertification examinations
2017 Impact of Potential Accreditation and Certification in Family Medicine Maternity Care Go to Impact of Potential Accreditation and Certification in Family Medicine Maternity Care
2020 Family Medicine Clerkship Directors’ Handling of Student Mistreatment: Results From a CERA Survey Go to Family Medicine Clerkship Directors’ Handling of Student Mistreatment: Results From a CERA Survey