Association Between Maintenance of Certification Examination Scores and Quality of Care for Medicare Beneficiaries

Abstract

Background: The relationship between physicians' cognitive skill and the delivery of evidence-based processes of care is not well characterized.Therefore, we set out to determine associations between general internists' performance on the American Board of Internal Medicine maintenance of certification examination and the receipt of important processes of care by Medicare patients. Methods: Physicians were grouped into quartiles based on their performance on the American Board of Internal Medicine examination. Hierarchical generalized linear models examined associations between examination scores and the receipt of processes of care by Medicare patients. The main outcome measures were the associations between diabetes care, using a composite measure of hemoglobin A 1c , and lipid testing and retinal screening, mammography, and lipid testing in patients with cardiovascular disease and the physician's performance on the American Board of Internal Medicine examination, adjusted for the number of Medicare patients with diabetes and cardiovascular disease in a physician's practice panel; frequency of visits; patient comorbidity, age, and ethnicity; and physician training history and type of practice. Results: Physicians scoring in the top quartile were more likely to perform processes of care for diabetes (composite measure odds ratio [OR], 1.17; 95% confidence interval [CI], 1.07-1.27) and mammography screening (OR, 1.14; 95% CI, 1.08-1.21) than physicians in the lowest physician quartile, even after adjustment for multiple factors. There was no significant difference among the groups in lipid testing of patients with cardiovascular disease (OR,

Relationship of Electronic Medical Knowledge Resource Use and Practice Characteristics with Internal Medicine Maintenance of Certification Examination Scores

“…[5][6][7] Certification examination scores correlate with training factors (type of medical school and residency program) 9,10 and assessments of competency by program directors, 11 and recertification scores discriminate between individuals with and without subspecialty content expertise. 12 A growing body of evidence demonstrates relationships between certification status and quality of care including outcomes following acute MI, [13][14][15] colorectal surgery, 16 diabetes care, 17 mammography screening, 17 and other preventive services. 18 Unfortunately, unrelenting time pressures in clinical practice have made it increasingly difficult for physicians to maintain habits of lifelong learning, 19,20 resulting in decrements in medical knowledge over time.…”

Setting a Fair Performance Standard for Physicians’ Quality of Patient Care

“…They had lower examination scores, consistent with the literature on the relationship between certification examination performance and quality of care. [24][25][26] They were judged to have lower overall clinical competence and poorer professional behavior/attitudes at the end of residency training, and frequently worked as solo practitioners. Furthermore, they tended to perform consistently low on most measures, not compensating for poor performance on intermediate outcome measures through superior performance on process measures.…”

International Federation for Emergency Medicine Model Curriculum for Continuing Professional Development

“…23 There is evidence that participation in CPD has a positive effect on knowledge acquisition and retention, though the evidence is weaker in terms of clinical outcomes. 5,6,[24][25][26] There is evidence of an association between maintenance of certification and some quality of care markers. 25 In relation to the question of which CPD formats are more effective, a major review of CPD in the USA and Canadian context recommended the use of multimedia, multiple instructional techniques, and multiple exposures to CPD content.…”

“…5,6,[24][25][26] There is evidence of an association between maintenance of certification and some quality of care markers. 25 In relation to the question of which CPD formats are more effective, a major review of CPD in the USA and Canadian context recommended the use of multimedia, multiple instructional techniques, and multiple exposures to CPD content. 5 Whilst there is evidence that unsolicited print materials are generally ineffective, 27 the use of single live media versus multiple media is not clear, though either is superior to print.…”