BACKGROUND:Although Internal Medicine year-end resident clinic handoffs affect numerous patients, little research has described patients' perspectives of the experience. OBJECTIVE: To describe patients' perceptions of positive and negative experiences pertaining to the year-end clinic handoff; to rate patient satisfaction with aspects of the clinic handoff and identify whether or not patients could name their new physicians. DESIGN: Qualitative study design using semi-structured interviews. PARTICIPANTS: High-risk patients who underwent a year-end clinic handoff in July 2011. MEASUREMENTS: Three months post-handoff, telephone interviews were conducted with patients to elicit their perceptions of positive and negative experiences. An initial coding classification was developed and applied to transcripts. Patients were also asked to name their primary care physician (PCP) and rate their satisfaction with the handoff. RESULTS: In all, 103 telephone interviews were completed. Patient experiences regarding clinic handoffs were categorized into four themes: (1) doctor-patient relationships (i.e. difficulty building rapport); (2) clinic logistics (i.e. difficulty rescheduling appointments); (3) process of the care transition (i.e. patient unaware transition occurred); and (4) patient safety-related issues (i.e. missed tests). Only 59 % of patients could correctly name their new PCP. Patients who reported that they were informed of the clinic transition by letter or by telephone call from their new PCP were more likely to correctly name them (65 % vs. 32 % p=0.007), report that their new doctor assumed care for them immediately ( Patients who reported being aware of the medical education mission of the clinic tended to be more understanding of the handoff process. CONCLUSIONS:Patients face unique challenges during year-end clinic handoffs and provide insights into areas of improvement for a patient-centered handoff.

Enhancing clinic handoffs can improve the handoff process, increase the likelihood of patients seeing the correct primary care provider within the target time frame, reduce missed tests, and possibly reduce acute visits.

An outbreak of SARS-CoV-2 in a skilled nursing facility (SNF) can be devastating for residents and staff. Difficulty identifying asymptomatic and pre-symptomatic cases and lack of vaccination or treatment options make management challenging. We created, implemented and now present a guide to rapidly deploy point prevalence testing and three-tiered cohorting in a SNF to mitigate an outbreak. We outline key challenges to SNF cohorting.

has had an impact on nutrition at individual, community, national, and global levels. 1 COVID-19 has been associated with weight loss and also has been linked to cachexia and sarcopenia. 2 Anorexia was the most common symptom during COVID-19 infection among patients at an academic long-term chronic care facility, with 70.8% of residents developing anorexia during the illness course. 3 In addition to effects of the disease itself, there are potential unintended consequences of infection control measures. A study of residents in a nursing home without a COVID-19 outbreak in the month following implementation of restrictions on visitors and group dining designed to mitigate the spread of COVID-19 showed significant weight loss among residents. 4 We conducted a retrospective chart review assessing the outcome of a COVID-19 outbreak on resident weights in a >200-bed skilled nursing facility (SNF) in Chicago, IL. The medical charts of each resident in the facility between March 1, 2020, and May 31, 2020, were reviewed in the electronic medical record (EMR) (PointClickCare) at the SNF and the affiliated academic medical center (Epic, 2020 Epic Systems Corporation). Among the residents included in the sample (n ¼ 209), the average age was 75.3 years (SD ¼ 11.9 years); residents were predominantly Black (93.3%) and women (56.0%). Hypertension (89.5%) and cognitive impairment (67.9%) were the most common chronic conditions present, followed by cardiac disease (43.5%) and diabetes (39.2%).There was no significant difference in age, race, gender, or comorbidities between the COVID-positive (n ¼ 172) and COVID-negative groups (n ¼ 32). Prevalence testing was completed for all residents in the facility twice at 7-day intervals in addition to as-needed testing based on symptoms and exposure. 5 The results of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction

Background/Objectives: Few studies present clinical management approaches and outcomes of coronavirus disease 2019 (COVID-19) outbreaks in skilled nursing facilities (SNFs). We describe outcomes of a clinical management pathway for a large COVID-19 outbreak in an urban SNF with predominantly racial minority (>90% black), medically complex, older residents.

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BACKGROUND: Few patient-centered interventions exist to improve year-end residency clinic handoffs. AIM: Our purpose was to assess the impact of a patientcentered transition packet and comic on clinic handoff outcomes. SETTING: The study was conducted at an academic medicine residency clinic. PARTICIPANTS: Participants were patients undergoing resident clinic handoffs 2011-2013 PROGRAM DESCRIPTION: Two months before the 2012 handoff, patients received a "transition packet" incorporating patient-identified solutions (i.e., a new primary care provider (PCP) welcome letter with photo, certificate of recognition, and visit preparation tool). In 2013, a comic was incorporated to stress the importance of follow-up.

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