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Dr. John Norcini, President Emeritus of the Foundation for Advancement of International Medical Education and Research (FAIMER®) has used Pennsylvania Health Care Cost Containment Council (PHC4) hospitalization data to conduct multiple studies on the relationship between physicians’ characteristics and patient health care outcomes.

In a paper published in Medical Education in 20171, Dr. Norcini’s research team evaluated Pennsylvania hospitalization data for several medical conditions including acute myocardial infarction, congestive heart failure, gastrointestinal hemorrhage, hip fracture and pneumonia over a seven-year period. The research group analyzed the effect of physician practice volume and time since medical school graduation, among other patient, physician, and hospital characteristics, on patients’ risk of in-hospital mortality. They found no statistically significant association between physicians’ recent practice volume and in-hospital mortality for all the conditions combined. However, the study showed that for each decade since graduation from medical school there was a 4.5% increase in relative risk for patient mortality. The study adjusted for potentially confounding variables such as patient severity of illness and other characteristics of the physicians and facilities.

Dr. Norcini used information provided by PHC4 in several ways. He explained, “Most importantly, the patients’ discharge information allowed us to determine the number of patients who died while in the hospital (i.e., in-hospital mortality rate). Mortality is one marker, among others, of the quality of patient care.” He also noted physicians are not the sole influence on how well patients respond to treatment, and the nature of the hospital can also make a difference in patient outcomes. He added, “Research indicates higher hospital volume is associated with better outcomes. From the PHC4 data, we could determine how many patients were treated in each hospital and statistically remove the effects of this on outcomes.”

Dr. Norcini indicated the data from PHC4 also formed the basis for other studies2,3 that evaluated the quality and efficiency of health care delivery. These studies focused on other aspects of the relationship between physician characteristics and patient outcomes, but PHC4’s hospitalization data were central to the studies.


1 Norcini JJ, Boulet JR, Opalek A, Dauphinee WD. Patients of doctors further from medical school graduation have poorer outcomes. Medical Education. 2017 May;51(5):480-489

2 Norcini JJ, Boulet JR, Opalek A, Dauphinee WD. Outcomes of cardiac surgery: Associations with physician characteristics, institutional characteristics, and transfers of care. Medical Care. 2013 Dec;51(12):1034-9

3 Norcini JJ, Boulet JR, Dauphinee WD, Opalek A, Krantz ID, Anderson ST. Evaluating the quality of care provided by graduates of international medical schools. Health Affairs. 2010 Aug;29(8):1461-8

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