• Online Features  This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (47)  • Contact me when this article is cited  Related Content  • Related letters  • Related articles  • Similar articles in this journal  Topic Collections  • Aging/ Geriatrics  • Medical Practice  • Medical Education  • Primary Care/ Family Medicine  • Quality of Care  • Quality of Care, Other  • Alert me on articles by topic  Social Bookmarking   What's this?

Eric S. Holmboe, MD; Yun Wang, PhD; Thomas P. Meehan, MD, MPH; Janet P. Tate, MPH; Shih-Yieh Ho, PhD, MPH; Katie S. Starkey, MHA; Rebecca S. Lipner, PhD

Arch Intern Med. 2008;168(13):1396-1403.

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, 1.00; 95% CI, 0.91-1.10).

Conclusion  Our findings suggest that physician cognitive skills, as measured by a maintenance of certification examination, are associated with higher rates of processes of care for Medicare patients.

Author Affiliations: American Board of Internal Medicine, Philadelphia, Pennsylvania (Drs Holmboe and Lipner and Ms Starkey), and Qualidigm, Middletown, Connecticut (Drs Wang, Meehan, and Ho and Ms Tate).

CiteULike    Connotea    Delicious    Digg    Facebook    Reddit    Technorati    Twitter     What's this?

RELATED LETTERS

Hemoglobin A_1c Testing, Board-Recertification Scores, and Treatment Outcomes
Simon G. Kassabian
Arch Intern Med. 2009;169(4):417.
EXTRACT | FULL TEXT  

Is Quality of Care Only Instrumental?
Joachim Sturmberg
Arch Intern Med. 2009;169(4):417-418.
EXTRACT | FULL TEXT  

Is Quality of Care Only Instrumental?—Reply
Eric S. Holmboe, Yun Wang, Thomas P. Meehan, Janet P. Tate, Shih-Yieh Ho, and Rebecca S. Lipner
Arch Intern Med. 2009;169(4):418.
EXTRACT | FULL TEXT  

RELATED ARTICLES

In This Issue of Archives of Internal Medicine
Arch Intern Med. 2008;168(13):1364.
FULL TEXT  

What Do Certification Examinations Tell Us About Quality?
Bruce E. Landon
Arch Intern Med. 2008;168(13):1365-1367.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Fairness and Effectiveness of Maintenance of Certification
Donohoe
Arch Intern Med 2011;171:1507-1507.
FULL TEXT  

Clinical Protocols and Trainee Knowledge About Mechanical Ventilation
Prasad et al.
JAMA 2011;306:935-941.
ABSTRACT | FULL TEXT  

Ready or Not, Here It Comes: Maintenance of Certification
Pinals
J Am Acad Psychiatry Law 2011;39:294-296.
FULL TEXT  

The roles of practice systems and individual effort in quality performance
Pham et al.
BMJQS 2011;20:704-710.
ABSTRACT | FULL TEXT  

Maintenance of certification: the profession's response to physician quality.
Miles
Ann Fam Med 2011;9:196-197.
FULL TEXT  

Family physician participation in maintenance of certification.
Xierali et al.
Ann Fam Med 2011;9:203-210.
ABSTRACT | FULL TEXT  

Maintenance of Certification in Internal Medicine: Facts and Misconceptions
Levinson and Holmboe
Arch Intern Med 2011;171:174-176.
FULL TEXT  

Putting the Secure Examination to the Test
Lipner and Lucey
JAMA 2010;304:1379-1380.
FULL TEXT  

Re: Future of Board Certification in a New Era of Public Accountability
Donohoe
J Am Board Fam Med 2010;23:687-687.
FULL TEXT  

Measuring Physicians' Performance in Clinical Practice: Reliability, Classification Accuracy, and Validity
Weifeng Weng et al.
Eval Health Prof 2010;33:302-320.
ABSTRACT  

The ASN In-Training Examination Needs More Time, Not a New Paradigm
Berns
CJASN 2010;5:1363-1365.
FULL TEXT  

Current Yardsticks May Be Inadequate For Measuring Quality Improvements From The Medical Home
Holmboe et al.
Health Aff (Millwood) 2010;29:859-866.
ABSTRACT | FULL TEXT  

Maintenance of Certification in Interventional Cardiology Revisited
George and Dangas
J Am Coll Cardiol Intv 2010;3:461-462.
FULL TEXT  

Association between primary care physicians' evidence-based medicine knowledge and quality of care
Shuval et al.
Int J Qual Health Care 2010;22:16-23.
ABSTRACT | FULL TEXT  

Medical Care for the Final Years of Life: "When You're 83, It's Not Going to Be 20 Years"
Reuben
JAMA 2009;302:2686-2694.
ABSTRACT | FULL TEXT  

A 37-Year-Old Man Trying to Choose a High-Quality Hospital: Review of Hospital Quality Indicators
Howell
JAMA 2009;302:2353-2360.
ABSTRACT | FULL TEXT  

Shared Medical Regulation in a Time of Increasing Calls for Accountability and Transparency: Comparison of Recertification in the United States, Canada, and the United Kingdom
Shaw et al.
JAMA 2009;302:2008-2014.
ABSTRACT | FULL TEXT  

Diagnostic Errors and Patient Safety
Wachter and Holmboe
JAMA 2009;302:258-258.
FULL TEXT  

Hemoglobin A1c Testing, Board-Recertification Scores, and Treatment Outcomes
Kassabian
Arch Intern Med 2009;169:417-417.
FULL TEXT  

Is Quality of Care Only Instrumental?--Reply
Holmboe et al.
Arch Intern Med 2009;169:418-418.
FULL TEXT  

Is Quality of Care Only Instrumental?
Sturmberg
Arch Intern Med 2009;169:417-418.
FULL TEXT  

Revalidation of physicians in Canada: Are we passing the test?
Levinson
CMAJ 2008;179:979-980.
FULL TEXT  

La revalidation des medecins au Canada : Passons-nous le test?
Levinson
CMAJ 2008;179:981-982.
FULL TEXT  

Recertification Scores Correlate with Quality of Care
Journal Watch Dermatology 2008;2008:2-2.
FULL TEXT  

Internal Medicine Board Exam Scores and Quality of Care
JWatch General 2008;2008:5-5.
FULL TEXT  

What Do Certification Examinations Tell Us About Quality?
Landon
Arch Intern Med 2008;168:1365-1367.
FULL TEXT