Resident and Residency Characteristics Associated With Self-reported Preparedness for Population Health Management

Population health management (PHM) is an important function of primary care with potential to improve outcomes and decrease costs, but is also among the most difficult strategies to implement in both practices and residency training. Our objective was to determine resident and residency program characteristics associated with graduates' reported preparation to perform PHM.

We used data from the American Board of Family Medicine (ABFM) Certification Examination registration questionnaire in 2014 and 2015 and ABFM administrative data. Resident PHM preparedness was assessed via a single, self-reported question. Bivariate analysis and logistic multilevel regression were performed to determine independent associations between characteristics and reported PHM preparedness. Odds ratios were converted to risk ratios given the high prevalence of the outcome.

Our sample included 6,135 residents from 442 family medicine residencies. Sixty-nine percent (n=4,240) reported being extremely or moderately prepared to perform PHM. No residency program characteristics showed an association with reported PHM preparedness. Resident characteristics independently associated with reported preparedness included being an international medical graduate (IMG) (RR=1.21 [1.07-1.35]) and of Hispanic ethnicity. Reporting greater preparedness to use health information tools, to lead quality improvement projects, and to provide care in different settings were also associated with reported PHM preparedness.

Similar to a study of practicing physicians, we found that IMGs are more likely to report preparedness to perform PHM. This suggests that elements of international medical education may better inculcate PHM principles, and that these elements could be used to produce physicians better prepared to manage population health.