Differences in Ambulatory Care Outcomes Between Trainees and Faculty: A Multi-center Study

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.

Duke Scholars

Author Joel Boggan Medicine, Hospital Medicine