American Journal of Managed Care (10/01/2019) Vol. 25, No. 10 Vandergrift, Jonathan L.; Gray, Bradley M.
A recent study sought to determine whether physicians' clinical knowledge moderates the relationship between practice infrastructure and quality of care. The authors focused on some 1,300 doctors certified in internal medicine between 1991 and 1993 or 2001 and 2003, who took the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) exam and completed ABIM's diabetes or hypertension registry during their 10-year recertification interval between 2011 and 2014. The subjects' composite care quality scores were regressed against the interaction between practice infrastructure and MOC scores with controls for physician, practice, and patient panel characteristics. Significant moderation of the connection between practice infrastructure and care quality was observed: improved practice infrastructure was associated with higher-quality care, particularly performance on process measures, solely among physicians scoring in the top two or three quintiles on their MOC exam. In one case, a top quintile practice infrastructure score was associated with 7.7% higher quality care higher among those scoring in the top quintile of the MOC exam, but it had no significance to quality among those scoring in the bottom quintile. "These findings suggest that evaluations of interventions designed to improve practice infrastructure should consider characteristics of the providers who comprise these practices, regardless of whether they are driven by differences in clinical knowledge or another correlated dimension of physician skill," the researchers conclude.