Table 2

Physician and patient characteristics by diagnostic exam performance tertile

TotalDiagnosis question per cent correctP value*
Top
(78.5–95.8)
Middle
(71.4–78.4)
Bottom
(42.9–71.3)
Exam performance, mean (SD)*
Diagnosis question per cent correct74.5 (0.4)84.3 (0.3)74.8 (0.1)65.5 (0.3)<0.001
Other question per cent correct72.6 (0.7)80.2 (1.0)72.1 (1.1)66.4 (1.5)<0.001
Treatment question per cent correct77.3 (0.3)83.4 (0.4)77.2 (0.4)72.0 (0.5)<0.001
Physician characteristics, count (%)
Female physician19 428 (39.9)6546 (43.8)6357 (37.5)6525 (39.0)0.37
US born physician28 462 (58.5)9284 (62.1)9932 (58.6)9246 (55.3)0.37
US medical school31 960 (65.7)10 471 (70.0)10 900 (64.3)10 589 (63.3)0.30
Practice type
 Solo physician practice9452 (19.4)1914 (12.8)3462 (20.4)4076 (24.4)0.009
 Small group practice (2–10)20 563 (42.3)5543 (37.1)7529 (44.4)7491 (44.8)0.19
 Medium physicians group practice (11–50)7442 (15.3)2899 (19.4)2402 (14.2)2141 (12.8)0.25
 Large physician group practice (>50 physicians)5391 (11.1)2150 (14.4)1655 (9.8)1586 (9.5)0.14
 Academic practice2708 (5.6)1447 (9.7)697 (4.1)564 (3.4)<0.001
 Other practice3076 (6.3)1005 (6.7)1211 (7.1)860 (5.1)0.59
Beneficiary characteristics
Beneficiary race, count (per cent)
 White40 086 (82.4)12 652 (84.6)13 778 (81.3)13 656 (81.7)0.13
 Black3958 (8.1)926 (6.2)1609 (9.5)1423 (8.5)0.03
 Other4588 (9.4)1380 (9.2)1569 (9.3)1639 (9.8)0.88
Beneficiary age (per year), mean (SD)*76.6 (0.1)76.8 (0.1)76.5 (0.1)76.6 (0.1)0.23
Chronic Condition Data Warehouse (CCW) conditions, count (per cent)
 Alzheimer’s disease and related disorders or senile dementia5151 (10.6)1497 (10.0)1793 (10.6)1861 (11.1)0.16
 Alzheimer’s disease2061 (4.2)627 (4.2)704 (4.2)730 (4.4)0.82
 Acute myocardial infarction1408 (2.9)394 (2.6)494 (2.9)520 (3.1)0.13
 Anaemia22 450 (46.2)6706 (44.8)7766 (45.8)7978 (47.7)0.11
 Asthma4424 (9.1)1313 (8.8)1548 (9.1)1563 (9.3)0.39
 Atrial fibrillation4225 (8.7)1265 (8.5)1478 (8.7)1482 (8.9)0.69
 Breast cancer2485 (5.1)779 (5.2)831 (4.9)875 (5.2)0.48
 Colorectal cancer1139 (2.3)357 (2.4)406 (2.4)376 (2.2)0.68
 Endometrial cancer352 (0.7)113 (0.8)109 (0.6)130 (0.8)0.39
 Lung cancer435 (0.9)151 (1.0)152 (0.9)132 (0.8)0.19
 Prostate cancer1662 (3.4)507 (3.4)600 (3.5)555 (3.3)0.66
 Cataract31 095 (63.9)9601 (64.2)10 773 (63.5)10 721 (64.1)0.74
 Heart failure9207 (18.9)2786 (18.6)3155 (18.6)3266 (19.5)0.54
 Chronic kidney disease6904 (14.2)2083 (13.9)2392 (14.1)2429 (14.5)0.62
 Chronic obstructive pulmonary disease9108 (18.7)2635 (17.6)3165 (18.7)3308 (19.8)0.02
 Depression12 042 (24.8)3728 (24.9)4145 (24.4)4169 (24.9)0.83
 Diabetes13 296 (27.3)3947 (26.4)4590 (27.1)4759 (28.5)0.16
 Glaucoma10 030 (20.6)3086 (20.6)3501 (20.6)3443 (20.6)0.99
 Hip/pelvic fracture1531 (3.1)430 (2.9)535 (3.2)566 (3.4)0.15
 Hyperlipidaemia37 132 (76.4)11 266 (75.3)12 898 (76.1)12 968 (77.6)0.11
 Benign prostatic hyperplasia5815 (12.0)1792 (12.0)1987 (11.7)2036 (12.2)0.76
 Hypertension37 607 (77.3)11 345 (75.8)13 011 (76.7)13 251 (79.3)<0.001
 Hypothyroidism11 425 (23.5)3490 (23.3)3862 (22.8)4073 (24.4)0.25
 Ischaemic heart disease18 713 (38.5)5616 (37.5)6393 (37.7)6704 (40.1)0.06
 Osteoporosis14 171 (29.1)4372 (29.2)4794 (28.3)5005 (29.9)0.34
 Rheumatoid arthritis23 352 (48.0)6879 (46.0)8275 (48.8)8198 (49.0)0.02
 Stroke6255 (12.9)1880 (12.6)2212 (13.0)2163 (12.9)0.70
Number of chronic conditions, count (per cent)
 ≤45066 (10.4)1459 (9.8)1744 (10.3)1863 (11.1)0.08
 5–716 861 (34.7)5392 (36.0)5981 (35.3)5488 (32.8)0.006
 8–1016 230 (33.4)4907 (32.8)5664 (33.4)5659 (33.8)0.35
 ≥1110 475 (21.5)3200 (21.4)3567 (21.0)3708 (22.2)0.28
Mental health visit, count (per cent)6347 (13.1)2040 (13.6)2119 (12.5)2188 (13.1)0.46
Hierarchical Condition Category score, mean (SD)*0.98 (0.01)0.96 (0.01)0.98 (0.01)0.99 (0.01)0.19
Household medium income, mean $ (SD)*59 852 (643)61 574 (1106)59 113 (1144)59 063 (1075)0.19
Medicaid dual eligible, count (per cent)6392 (13.1)1793 (12.0)2411 (14.2)2188 (13.1)0.28
Rural county residence, count (per cent)7392 (15.2)2207 (14.8)2866 (16.9)2319 (13.9)0.64
Visit characteristics
Visit with same doctor in last year, count (per cent)37 726 (77.6)11 369 (76.0)13 154 (77.6)13 203 (79.0)0.08
Visit with any physician in last year, count (per cent)44 852 (92.2)13 711 (91.7)15 647 (92.3)15 494 (92.7)0.08
Days since last visit with any physician (if any visit in last year), mean (SD)*144.2 (0.6)147.1 (0.8)144.4 (1.0)141.4 (1.3)<0.001
ED visit in prior year, count (per cent)8101 (16.7)2428 (16.2)2879 (17.0)2794 (16.7)0.43
Days since last ED visits (if ED visit in last year), mean (SD)*222.8 (0.9)221.2 (1.5)223.5 (1.5)223.4 (1.5)0.47
Hospitalisation in prior year, count (per cent)4227 (8.7)1280 (8.6)1489 (8.8)1458 (8.7)0.85
Days since last hospitalisation (if hospitalisation in last year), mean (SD)*229.6 (1.2)229.1 (2.1)229.7 (2.1)230.1 (1.9)0.95
Index visit diagnosis groups, count (per cent)
 Abscess1005 (2.1)268 (1.8)394 (2.3)343 (2.1)0.21
 Anaemia12 410 (25.5)3817 (25.5)4369 (25.8)4224 (25.3)0.93
 Aortic aneurysm11 491 (23.6)3495 (23.4)4165 (24.6)3831 (22.9)0.18
 Appendicitis2584 (5.3)845 (5.6)949 (5.6)790 (4.7)0.01
 Bacteraemia5567 (11.4)1660 (11.1)1929 (11.4)1978 (11.8)0.83
 Congestive heart failure12 137 (25.0)3633 (24.3)4221 (24.9)4283 (25.6)0.67
 Acute coronary syndrome16 228 (33.4)4627 (30.9)5740 (33.9)5861 (35.1)0.02
 Depression12 637 (26.0)3932 (26.3)4312 (25.4)4393 (26.3)0.78
 Fracture13 409 (27.6)4324 (28.9)4364 (25.7)4721 (28.2)0.11
 Pulmonary embolism8534 (17.5)2683 (17.9)2984 (17.6)2867 (17.1)0.71
 Pneumonia12 183 (25.1)3773 (25.2)4224 (24.9)4186 (25.0)0.97
 Spinal cord compression6386 (13.1)1985 (13.3)2218 (13.1)2183 (13.1)0.94
 Stroke10 026 (20.6)3003 (20.1)3542 (20.9)3481 (20.8)0.79
  • *P values and SD accounted for correlated errors within physicians.

  • ED, emergency department.