Research ArticleORIGINAL RESEARCH

Physicians’ Choice of Board Certification Activity Is Unaffected by Baseline Quality of Care: The TRADEMaRQ Study

Lars E. Peterson, John Johannides and Robert L. Phillips
The Annals of Family Medicine March 2022, 20 (2) 110-115; DOI: https://doi.org/10.1370/afm.2770

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  • Table 1.

    Characteristics of Participating Physicians

    CharacteristicOverall (N = 254)Study Group
    Intervention (n = 130)Control (n = 124)P Value
    Age for tertile, mean (SD), ya.31
        <43.4939.0 (2.9)39.3 (2.7)38.8 (3.1)
        43.49-55.048.3 (3.3)48.2 (3.3)48.5 (3.3)
        >55.062.4 (4.3)63 (4.5)61.8 (4.0)
    Female, No. (%)143 (56.3)74 (56.9)69 (55.7).94
    MD degree (vs DO degree), No. (%)236 (92.9)124 (95.4)112 (90.3).12
    International medical graduate, No. (%)19 (7.5)7 (5.4)12 (9.7).20
    Most recent ABFM Certification Examination score for tertile, mean (SD)b.76
        <530470.4 (44.8)468.8 (44.8)472.3 (45.3)
        530-620583.3 (24.2)586.1 (25.6)580.9 (22.9)
        >620686.3 (48.8)688.1 (49.0)684.2 (49.1)
    Organization, No. (%).10
        KPWA90 (35.4)54 (41.5)36 (29.0)
        KPCO64 (25.2)26 (20.0)38 (30.7)
        OCHIN94 (37.0)46 (35.4)48 (38.7)
        SETMA6 (2.4)4 (3.1)2 (1.6)

    • ABFM = American Board of Family Medicine; DO = doctor of osteopathic medicine; KPCO = Kaiser Permanente Colorado; KPWA = Kaiser Permanente Washington; MD = doctor of medicine; OCHIN = a nonprofit health care innovation center focused on the needs of community health centers, small practices, and critical access hospitals; SETMA = Southeast Texas Medical Associates.

    • ↵a In study population overall, 84 physicians fell into bottom (youngest) tertile, 87 physicians into middle tertile, and 83 physicians into top (oldest) tertile.

    • ↵b In study population overall, 94 physicians fell into bottom tertile, 82 physicians into middle tertile, and 78 physicians into top tertile.

  • Table 2.

    Physicians’ Use of the Quality Measure Dashboard in the Intervention Group (N = 130)

    Dashboard UseOverall (N = 130)Organization
    KPWA (n = 54)KPCO (n = 26)OCHIN (n = 46)SETMA (n = 4)
    Never reviewed dashboard during 3-year study period, No. (%)24 (18.4)9 (16.7)9 (34.6)5 (10.9)1 (25.0)
    Reviewed dashboard in the 2 weeks before certification activity, No. (%)59 (45.4)23 (42.6)9 (34.6)27 (58.7)0 (0.0)
    Time spent reviewing dashboard in the 2 weeks before certification activity, median (IQR), seca82 (52-155)86 (55-131)75 (43-179)85 (53-156)0 (0-0)

    • IQR = interquartile range; KPCO = Kaiser Permanente Colorado; KPWA = Kaiser Permanente Washington; OCHIN = a nonprofit health care innovation center focused on the needs of community health centers, small practices, and critical access hospitals; SETMA = Southeast Texas Medical Associates.

    • ↵a Among those who reviewed dashboard in the 2 weeks before certification activity.

  • Table 3.

    Proportion of Chosen Certification Activities That Addressed Quality Gaps

    SampleChosen Certification Activities That Addressed Quality Gaps, Mean (SD) %
    OverallStudy Group
    InterventionControlP Value
    Total27.2 (28.5)28.8 (31.1)25.7 (25.9).94
    Organization
        KPWA13.6 (28.3)17.7 (34.1)6.4 (10.2).86
        KPCO22.0 (19.5)25.2 (23.5)20.1 (16.7).59
        OCHIN38.4 (29.4)40.6 (28.9)36.6 (30.0).52
        SETMAa57.9 (7.1)50 (...)61.8 (2.6)

    • KPCO = Kaiser Permanente Colorado; KPWA = Kaiser Permanente Washington; OCHIN = a nonprofit health care innovation center focused on the needs of community health centers, small practices, and critical access hospitals; SETMA = Southeast Texas Medical Associates.

    • Notes: Quality gaps were defined as quality areas in which the physician scored below the mean for the whole study population.

    • ↵a Only 6 SETMA physicians participated in study.

  • Table 4.

    Association of Study Group and Physician Characteristics With Choosing Certification Activities That Addressed Quality Gaps

    VariableChosen Activities Addressed Quality Gaps, OR (95% CI)P Value
    Study group: intervention vs control1.28 (0.90-1.82).17
    Physician characteristics
    Age tertile, y.30
        <43.49Reference
        43.49-54.90.94 (0.61-1.46)
        >54.90.72 (0.47-1.11)
    Male1.51 (1.06-2.16).02
    MD degree (vs DO degree)1.14 (0.63-2.07).67
    International medical graduate1.45 (0.75-2.78).27
    Most recent ABFM Certification Examination score tertile<.001
        <530Reference
        530-6200.40 (0.25-0.64)
        >6200.69 (0.46-1.05)
    Organization<.001
        KPWAReference
        KPCO2.06 (1.09-3.90)
        OCHIN4.54 (2.52-8.18)
        SETMA5.76 (1.48-22.43)

    • ABFM = American Board of Family Medicine; DO = doctor of osteopathic medicine; KPCO = Kaiser Permanente Colorado; KPWA = Kaiser Permanente Washington; MD = doctor of medicine; OCHIN = a nonprofit health care innovation center focused on the needs of community health centers, small practices, and critical access hospitals; OR = odds ratio; SETMA = Southeast Texas Medical Associates.

    • Note: Quality gaps were defined as quality areas in which the physician scored below the mean for the whole study population.

  • Table 5.

    Association of Dashboard Time and Physician Characteristics With Choosing Certification Activities That Addressed Quality Gaps Among Intervention Physicians

    VariableChosen Activities Addressed Quality Gaps, OR (95% CI)
    Model 1aModel 2b
    Time reviewing dashboard: ≤80 sec vs >80 sec1.09 (0.46-2.55)0.91 (0.39-2.08)
    Physician characteristics
    Age tertile, y
        <43.49ReferenceReference
        43.9-54.91.81 (0.73-4.49)0.87 (0.31-2.48)
        >54.91.01 (0.36-2.86)1.67 (0.68-4.10)
    Male1.84 (0.84-4.83)2.13 (0.97-4.67)
    MD degree (vs DO degree)0.31 (0.05-1.90)0.28 (0.05-1.78)
    International medical graduate4.55 (0.76-27.11)5.20 (0.86-31.58)
    Most recent ABFM Certification Examination score tertile
        <530ReferenceReference
        530-6200.68 (0.25-1.84)1.62 (0.54-4.83)
        >6201.37 (0.46-4.14)0.70 (0.26-1.90)
    Organization
        KPWAReferenceReference
        KPCO1.64 (0.32-8.34)1.92 (0.39-9.54)
        OCHIN2.36 (0.63-8.88)3.05 (0.84-11.00)
        SETMAc

    • ABFM = American Board of Family Medicine; DO = doctor of osteopathic medicine; KPCO = Kaiser Permanente Colorado; KPWA = Kaiser Permanente Washington; MD = doctor of medicine; OCHIN = a nonprofit health care innovation center focused on the needs of community health centers, small practices, and critical access hospitals; OR = odds ratio; SETMA = Southeast Texas Medical Associates.

    • Note: Quality gaps were defined as quality areas in which the physician scored below the mean for the whole study population.

    • ↵a Based on total time reviewing dashboard in the 2 weeks before certification activity and 166 chosen certification activities.

    • ↵b Based on total time reviewing dashboard in the 3 weeks before certification activity and 191 chosen certification activities.

    • ↵c None of the SETMA physicians used the quality dashboard in the 2 weeks or in the 3 weeks before their certification activity.

Additional Files

  • SUPPLEMENTAL MATERIALS IN PDF, LINK BELOW

    • PetersonSupp.pdf -

      Supplemental Table 1. Clinical Measures From Each Participation Organization


      Supplemental Table 2. Number of Family Medicine Certification Activities Completed by Study Participants From 2015 to 2017

      Supplemental Table 3. Association Between Physician Characteristics and Choosing to Work on Certification Activities With Below-Average Quality Measures by Organization. Excluding SETMA

      Supplemental Figure 1. Mock-up of Expanded Quality Measure Dashboard as Part of the Intervention
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