Abstract
BACKGROUND: Academic medical centers (AMCs) provide the nation's most complex care, with no differences in performance between trainees and faculty for inpatient outcomes. Single-center analyses demonstrated low performance on ambulatory outcomes among residents vs. faculty.
OBJECTIVE: Determine whether resident-faculty ambulatory care performance disparities are a national problem, understand contributing factors present in AMCs.
DESIGN: Retrospective cohort study, survey-based study PARTICIPANTS: A total of 146,961 patients receiving primary care at five AMCs within resident-faculty primary care training practices during calendar year 2019. Resident clinic directors at each of the sites participated in the survey-based analysis.
MAIN MEASURES: The main exposure was whether the patients received primary care in a faculty-supervised resident vs. faculty-only cohort. Outcome measures included rates of colorectal and breast cancer screening and control of type 2 diabetes mellitus and hypertension between the resident and faculty cohorts. We also assessed the level of agreement with five components of high-functioning primary care as defined by the National Academies of Sciences in interviews with residency practice leadership.
KEY RESULTS: After adjustment for key differences in social complexity, we observed resident-faculty disparities across all five sites for all outcomes, with disparities in breast cancer screening from RR 0.69 (0.62-0.78)-0.71 (0.63-0.80); disparities in colorectal cancer screening from RR 0.77 (0.68-0.88) to 0.90 (0.86-0.93); disparities in control of type 2 diabetes mellitus from RR 0.82 (0.69-0.97) to 0.90 (0.86-0.93); and disparities in control of hypertension from RR 0.79 (0.68-0.91) to 0.87 (0.79-0.95). The magnitude of resident-faculty performance disparities may be related to the likelihood of disagreement with the five components of high-functioning primary care.
CONCLUSIONS: Residents performed lower than faculty on routine ambulatory quality measures. The magnitude and number of disparities may be related to disagreement on the presence of components of high-functioning primary care. These findings highlight the need for more robust infrastructural support in primary care settings to meet the needs of patients.