Beyond diagnosis: Patient mix and challenges to patient care in ambulatorytraining sites

Background: Educational experiences in ambulatory medicine vary by site. Pu rpose: To evaluate variations in patient mix and challenges in patient care at 3 ambulatory training sites. Method: Patients (n=123) receiving care at a VA medical center (VA), an urban academic medical center's primary care center (PCC), and a community group practice (CCP) were evaluated. Results: Patients at the VA (n=55), compared with those at the PCC (n=44) and the C GP (n=24), were older, more likely to be male, and white (all P < 0.05). Pa tients at the VA and the PCC reported difficulty with functional and health status more frequently than those at the CGP (all P < 0.05). Common medica l diagnoses varied across sites and comorbidity scores were greater than or equal to 2 in 48% of VA subjects compared with 16% at the PCC and 29% at t he CGP (P < 0.05). Challenges most frequently cited were administrative iss ues at the VA (44%), patient-physician communication at the PCC (39%), and medical decisions at the CGP (50%) (P < 0.05). Conclusions: Ambulatory trai ning sites can differ greatly with respect to characteristics beyond diagno sis. Plans for increased and improved ambulatory training of internal medic ine residents should include attention to these issues to ensure exposure t o an adequate patient spectrum.