Educating Physicians and Treating Patients in the Ambulatory Setting

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Abstract
We evaluated 15 group practices in general internal medicine in university hospitals with regard to access to and quality of care, patients'' satisfaction with that care, and quality of residency education provided. We used these data to speculate about potential changes in ambulatory care programs in university teaching hospitals. All 15 practices participated for 4 years. One third of their patient population had no medical insurance. Practice patients had twice as many chronic illneses as did the general poulation, and two fifths of patients stayed at least 2 years in the practice. Few faculty members spent more than 14 hours weekly in teh practices, and housestaff worked an average of 4 hours per week. Patient waiting times did not meed ideal standards, but patient satisfaction was higher than in a general population. Compliance with quality of care criteria was not exceptional; for example, 10% of eligible patients received an annual influenza vaccination. Housestaff assigned a relatively low ranking to their educational experience in these practices. We recommend the institution of additional experimental programs in ambulatory care and housestaff education to improve the quality of care in the ambulatory setting. [MeSH terms: activities of daily living; ambulatory care;chronic disease; continuity of patient care; delivery of health care; diabetes mellitus; group practice; health services accessibility; hospitals, university; hypertension; internal medicine; internship and residency; obesity; physicians; quality of health care].

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