Do Professional Development Programs for Maintenance of Certification (MOC) Affect Quality of Patient Care?

Article Figures & Data

Table 1. Clinical Process and Intermediate Patient Outcomes for the Before and After Periods Obtained for Patients of DARTNet Study Physicians

Individual Clinical Measures	Outcome Description
1. Hemoglobin A1C
1A. Process outcome (date)	Every 12 months
1B. Intermediate patient outcome (level)	<8%
2. Blood pressure (systolic and diastolic)
2A. Process outcome (date)	Every 12 months
2B. Intermediate patient outcome (level)	Systolic <140, diastolic <90
3. Low-density lipoprotein cholesterol
3A. Process outcome (date)	Every 12 months
3B. Intermediate patient outcome (level)	<100 mg/dL
4. Protein-to-creatinine ratio
4A. Process outcome (date)	Every 12 months
4B. Intermediate patient outcome (level)	<30 mg/mmol
5. Angiotensin-converting enzyme and angiotensin receptor blocker
5A. Process outcome (date)	Every 12 months
5B. Intermediate patient outcome (date)	Every 12 months
6. Albumin-to-creatinine ratio
6A. Process outcome (date)	Every 12 months
6B. Intermediate patient outcome (date)	<30 mg/dL

Table 2. DARTNet Physician Study Groups and Eligible Patients at Before and at After Completion of SAM/PPM Periods

↵* There were an additional 3 doctors in this group who were excluded from analysis because of a lack of any eligible patients.
↵† There were an additional 7 doctors in this group who were excluded from analysis because of a lack of any eligible patients.
SAM/PPM, Self-assessment Module/Performance in Practice Module.

Table 3. Process Outcomes

Group	Time	Foot Exam	ACE	Hemoglobin A1C Check	BP check	LDL Check	Albumin-to-Creatinine Ratio Check	Comp LP^* (Average Score)
1. Diabetes	Before	9.20	15.10	49.44	61.30	49.40	12.97	1.99
1. Diabetes	After	19.40	24.90	70.70	84.80	68.50	25.97	2.96
Absolute difference		10.20	9.80	21.26	23.50	19.10	13.00	0.97
P value^{^†}		.0024	.0003	.9757	<.0001	.9215	.8238	.1713
2. Other	Before	4.90	24.80	38.90	58.30	37.10	16.11	1.80
2. Other	After	14.70	18.10	73.80	84.20	72.80	37.82	3.02
Absolute difference		9.80	−6.70	34.90	25.90	35.70	21.71	1.22
P value^{^‡}		.0007	<.0001	<.0001	<.0001	<.0001	<.0001	<.0001
3. None	Before	3.70	19.30	58.40	65.70	51.20	18.90	2.18
3. None	After	18.70	21.40	79.70	82.60	70.50	32.31	3.06
Absolute difference		15.00	2.10	21.30	16.90	19.30	13.41	0.88

Data are percentages unless otherwise indicated.
↵* Comp LP is the average of the sum of all measures at the patient level (possible score of 0–6).
↵† For diabetes (group 1) vs. none (group 3).
↵‡ For other (group 2) vs. none (group 3).
ACE, angiotensin-converting enzyme; BP, blood pressure; LDL, low-density lipoprotein.

Table 4. Intermediate Outcomes

Group	Time	Hemoglobin A1C	BP	LDL	Albumin-to-Creatinine Ratio	Comp LI^* (Average Score)
1. Diabetes	Before	22.5	54.7	33.7	10.2	1.46
1. Diabetes	After	33.2	76.6	50.8	20.5	2.26
Absolute difference		10.5	21.9	17.1	10.3	0.80
P value^{^†}		.3417	<.0001	.1702	.7982	.0048
2. Other	Before	20.7	49.3	26.0	11.3	1.37
2. Other	After	34.3	74.0	47.9	27.4	2.17
Absolute difference		13.6	24.7	21.9	16.1	0.79
P value^{^‡}		.5043	<.0001	.0001	.0008	.0504
3. None	Before	29.1	57.0	32.8	13.8	1.56
3. None	After	41.5	71.3	47.1	24.5	2.25
Absolute difference		12.4	14.3	14.3	10.7	0.69

Data are percentages unless otherwise indicated.
↵* Comp LI is the average of the sum of all measures at the patient level (possible score of 0–4).
↵† Diabetes (group 1) vs. none (group 3).
↵‡ Other (group 2) vs. none (group 3).
BP, blood pressure; LDL, low-density lipoprotein.