里程碑评分与家庭医生早期糖尿病管理的相关性。

IF 1.8 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL
Sean O Hogan, Kenji Yamazaki, Eric S Holmboe
{"title":"里程碑评分与家庭医生早期糖尿病管理的相关性。","authors":"Sean O Hogan, Kenji Yamazaki, Eric S Holmboe","doi":"10.22454/FamMed.2025.980357","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and objectives: </strong>Family physicians manage the treatment of patients with chronic illnesses like type 2 diabetes mellitus (T2DM). During residency, trainees are assessed on their management of chronic disease under the Accreditation Council for Graduate Medical Education patient care (PC) milestone. Residency programs are expected to ensure that trainees are prepared to meet patients' needs; however, evidence is mixed as to whether milestone evaluations predict how well a physician will perform in early unsupervised practice. This study tested whether higher PC milestone evaluations predict greater adherence to T2DM guidelines for early-career family physicians.</p><p><strong>Methods: </strong>Using national provider identification numbers, we linked family medicine trainees' penultimate PC milestones with commercial insurance claims for T2DM patients. We associated doctors with patients by identifying the doctors who performed the evaluation and maintenance exams and observing the extent to which those patients received HbA1c, retinal, and renal functioning exams. We followed doctors who graduated in June 2016 through the first 18 months of unsupervised practice.</p><p><strong>Results: </strong>Milestones were not significantly associated with screening outcomes: HbA1c (OR=0.963, 95% CI [0.840, 1.104]), nephropathy (OR=0.983, 95% CI [0.901, 1.072]), or eye exam (OR=1.001, 95% CI [0.936, 1.070]). Rather, for every additional diabetes patient a family physician saw, administration of standard tests increased: HbA1c (OR=1.005, 95% CI [1.002, 1.009]) and nephropathy (OR=1.004, 95% CI [1.002, 1.006]).</p><p><strong>Conclusions: </strong>Milestones for chronic disease management were not correlated with diabetes management for early career family physicians. The volume of diabetic patients under a doctor's care was positively correlated with levels of expected screenings.</p>","PeriodicalId":50456,"journal":{"name":"Family Medicine","volume":"57 2","pages":"83-90"},"PeriodicalIF":1.8000,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11922144/pdf/","citationCount":"0","resultStr":"{\"title\":\"Correlation of Milestone Ratings and Family Physicians' Early Diabetes Management.\",\"authors\":\"Sean O Hogan, Kenji Yamazaki, Eric S Holmboe\",\"doi\":\"10.22454/FamMed.2025.980357\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background and objectives: </strong>Family physicians manage the treatment of patients with chronic illnesses like type 2 diabetes mellitus (T2DM). During residency, trainees are assessed on their management of chronic disease under the Accreditation Council for Graduate Medical Education patient care (PC) milestone. Residency programs are expected to ensure that trainees are prepared to meet patients' needs; however, evidence is mixed as to whether milestone evaluations predict how well a physician will perform in early unsupervised practice. This study tested whether higher PC milestone evaluations predict greater adherence to T2DM guidelines for early-career family physicians.</p><p><strong>Methods: </strong>Using national provider identification numbers, we linked family medicine trainees' penultimate PC milestones with commercial insurance claims for T2DM patients. We associated doctors with patients by identifying the doctors who performed the evaluation and maintenance exams and observing the extent to which those patients received HbA1c, retinal, and renal functioning exams. We followed doctors who graduated in June 2016 through the first 18 months of unsupervised practice.</p><p><strong>Results: </strong>Milestones were not significantly associated with screening outcomes: HbA1c (OR=0.963, 95% CI [0.840, 1.104]), nephropathy (OR=0.983, 95% CI [0.901, 1.072]), or eye exam (OR=1.001, 95% CI [0.936, 1.070]). Rather, for every additional diabetes patient a family physician saw, administration of standard tests increased: HbA1c (OR=1.005, 95% CI [1.002, 1.009]) and nephropathy (OR=1.004, 95% CI [1.002, 1.006]).</p><p><strong>Conclusions: </strong>Milestones for chronic disease management were not correlated with diabetes management for early career family physicians. The volume of diabetic patients under a doctor's care was positively correlated with levels of expected screenings.</p>\",\"PeriodicalId\":50456,\"journal\":{\"name\":\"Family Medicine\",\"volume\":\"57 2\",\"pages\":\"83-90\"},\"PeriodicalIF\":1.8000,\"publicationDate\":\"2025-02-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11922144/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Family Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.22454/FamMed.2025.980357\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"MEDICINE, GENERAL & INTERNAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Family Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.22454/FamMed.2025.980357","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
引用次数: 0

摘要

背景和目的:家庭医生管理2型糖尿病(T2DM)等慢性疾病患者的治疗。在实习期间,根据研究生医学教育病人护理(PC)里程碑认证委员会对学员的慢性疾病管理进行评估。住院医师计划应确保受训人员准备好满足患者的需求;然而,关于里程碑评估是否能预测医生在早期无监督实践中的表现好坏,证据不一。本研究测试了较高的PC里程碑评估是否预示着早期职业家庭医生更遵守T2DM指南。方法:使用国家提供者识别号码,我们将家庭医学学员的第二个PC里程碑与2型糖尿病患者的商业保险索赔联系起来。我们通过确定进行评估和维持检查的医生,并观察这些患者接受HbA1c、视网膜和肾功能检查的程度,将医生与患者联系起来。我们对2016年6月毕业的医生进行了前18个月的无监督实习。结果:里程碑与筛查结果无显著相关性:糖化血红蛋白(OR=0.963, 95% CI[0.840, 1.104])、肾病(OR=0.983, 95% CI[0.901, 1.072])或眼科检查(OR=1.001, 95% CI[0.936, 1.070])。相反,家庭医生每增加一个糖尿病患者,标准检查的实施就会增加:糖化血红蛋白(OR=1.005, 95% CI[1.002, 1.009])和肾病(OR=1.004, 95% CI[1.002, 1.006])。结论:早期职业家庭医生的慢性疾病管理里程碑与糖尿病管理无关。接受医生治疗的糖尿病患者数量与预期筛查水平呈正相关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Correlation of Milestone Ratings and Family Physicians' Early Diabetes Management.

Background and objectives: Family physicians manage the treatment of patients with chronic illnesses like type 2 diabetes mellitus (T2DM). During residency, trainees are assessed on their management of chronic disease under the Accreditation Council for Graduate Medical Education patient care (PC) milestone. Residency programs are expected to ensure that trainees are prepared to meet patients' needs; however, evidence is mixed as to whether milestone evaluations predict how well a physician will perform in early unsupervised practice. This study tested whether higher PC milestone evaluations predict greater adherence to T2DM guidelines for early-career family physicians.

Methods: Using national provider identification numbers, we linked family medicine trainees' penultimate PC milestones with commercial insurance claims for T2DM patients. We associated doctors with patients by identifying the doctors who performed the evaluation and maintenance exams and observing the extent to which those patients received HbA1c, retinal, and renal functioning exams. We followed doctors who graduated in June 2016 through the first 18 months of unsupervised practice.

Results: Milestones were not significantly associated with screening outcomes: HbA1c (OR=0.963, 95% CI [0.840, 1.104]), nephropathy (OR=0.983, 95% CI [0.901, 1.072]), or eye exam (OR=1.001, 95% CI [0.936, 1.070]). Rather, for every additional diabetes patient a family physician saw, administration of standard tests increased: HbA1c (OR=1.005, 95% CI [1.002, 1.009]) and nephropathy (OR=1.004, 95% CI [1.002, 1.006]).

Conclusions: Milestones for chronic disease management were not correlated with diabetes management for early career family physicians. The volume of diabetic patients under a doctor's care was positively correlated with levels of expected screenings.

求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
Family Medicine
Family Medicine 医学-医学:内科
CiteScore
2.40
自引率
21.10%
发文量
0
审稿时长
6-12 weeks
期刊介绍: Family Medicine, the official journal of the Society of Teachers of Family Medicine, publishes original research, systematic reviews, narrative essays, and policy analyses relevant to the discipline of family medicine, particularly focusing on primary care medical education, health workforce policy, and health services research. Journal content is not limited to educational research from family medicine educators; and we welcome innovative, high-quality contributions from authors in a variety of specialties and academic fields.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信