Toward graduate medical education (GME) accountability: measuring the outcomes of GME institutions.
Toward graduate medical education (GME) accountability: measuring the outcomes of GME institutions.
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DOI：
10.1097/acm.0b013e31829a3ce9
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发表时间：
2013-09
期刊：
影响因子：
--
通讯作者：
O'Donnell SD
中科院分区：
文献类型：
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作者：
Chen C;Petterson S;Phillips RL;Mullan F;Bazemore A;O'Donnell SD
研究生医学教育（GME）在美国卫生保健劳动力中发挥着关键作用，决定了其总体规模和专业分布，并影响了医生的执业地点。医疗保险每年提供近100亿美元用于支持GME，并面临着越来越多的政策制定者对制定问责制措施的兴趣。本研究的目的是开发和测试候选人GME结果的措施有关的医生的劳动力。作者对美国医学会医师主文件、国家提供者标识符文件、医疗保险索赔和国家医疗服务团的数据进行了二次分析，测量了2006年至2008年在高需求专业和服务不足领域执业的毕业生的数量和百分比。他们的美国GME计划。在研究期间，平均整体初级保健生产率为25.2%，尽管这是一个高估，因为不能排除住院医生。在759所赞助机构中，158所没有初级保健毕业生，184所毕业生超过80%。平均37.9%的内科住院医师留在初级保健，包括住院医生。平均普外科保留率为38.4%。总体而言，4.8%的毕业生在农村地区执业; 198所机构没有产生农村医生，283所机构没有产生联邦合格的卫生中心或农村卫生诊所医生。对大多数机构和培训地点来说，全球监测和评价的成果是可以衡量的。专业和地理位置差异很大。这些研究结果可以为教育工作者和政策制定者提供信息，因为越来越多的人呼吁将全球监测和评价系统与国家卫生需求相结合。
Graduate medical education (GME) plays a key role in the U.S. health care workforce, defining its overall size and specialty distribution, and influencing physician practice locations. Medicare provides nearly $10 billion annually to support GME, and faces growing policymaker interest in creating accountability measures. The purpose of this study was to develop and test candidate GME outcome measures related to physician workforce. The authors performed a secondary analysis of data from the American Medical Association Physician Masterfile, National Provider Identifier file, Medicare claims, and National Health Service Corps, measuring the number and percentage of graduates from 2006 to 2008 practicing in high-need specialties and underserved areas aggregated by their U.S. GME program. Average overall primary care production rate was 25.2% for the study period, although this is an overestimate since hospitalists could not be excluded. Of 759 sponsoring institutions, 158 produced no primary care graduates, and 184 produced more than 80%. An average of 37.9% of Internal Medicine residents were retained in primary care, including hospitalists. Mean general surgery retention was 38.4%. Overall, 4.8% of graduates practiced in rural areas; 198 institutions produced no rural physicians, and 283 institutions produced no Federally Qualified Health Center or Rural Health Clinic physicians. GME outcomes are measurable for most institutions and training sites. Specialty and geographic locations vary significantly. These findings can inform educators and policy-makers during a period of increased calls to align the GME system with national health needs.