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

TLDR

The link between physicians’ cognitive abilities and the delivery of evidence‑based care remains poorly understood. This study examined whether general internists’ scores on the American Board of Internal Medicine maintenance of certification exam are associated with Medicare patients’ receipt of key processes of care. Internists were ranked into quartiles by exam score and hierarchical generalized linear models assessed associations between scores and processes of care, adjusting for patient and practice characteristics. Physicians in the top quartile were 17% more likely to provide diabetes care and 14% more likely to offer mammography screening than those in the lowest quartile, while lipid testing rates for cardiovascular patients did not differ.

Abstract

<h3>Background</h3> 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. <h3>Methods</h3> 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. <h3>Results</h3> 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). <h3>Conclusion</h3> 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.