Enhanced Scheduling Support to Improve Continuity of Care in a Resident Training Clinic

Abstract

Background Clinical continuity is recognized as a driver of satisfaction for patients and physicians. Greater continuity may positively affect trainee decisions to enter primary care. Maintaining clinical continuity remains a challenge in residency clinics. Objective We determined whether enhanced scheduling support was associated with improvement in internal medicine resident continuity with patients. Methods This study was conducted from June 2017 to December 2018. In the intervention clinic, a single scheduling staff member (ratio of 10 residents to 1 scheduler) was colocated within the clinical space, allowing the scheduler to participate in clinical discussions and direct communication with physicians regarding future appointments. In the comparison clinic, scheduling staff (19:1 ratio) were located at a remote front desk area and relied on patient reports or electronic health record orders to identify appointment needs and arrange follow-up appointments. The main outcome of the intervention was resident continuity, calculated using the continuity for physician formula. Results During the study period, mean resident continuity was 23% (range 13%–37%) in the comparison clinic (57 residents) and 54% (range 38%–66%) in the intervention clinic (10 residents). Resident continuity was significantly higher in the intervention clinic compared with the traditional control clinic for every quarter measured ( P < .001 for all comparisons). Conclusions Enhancing scheduling support through colocation and a lower resident to scheduler ratios was associated with significantly higher rates of resident continuity compared with a traditional front desk model, with results sustained over 18 months.

Uses of Electronic Health Record Data to Measure the Clinical Learning Environment of Graduate Medical Education Trainees: A Systematic Review

“…Following full-text review, an additional 154 articles lacked inclusion criteria and were excluded. Our final review contained 86 articles 6–91 (for complete extracted data, see Supplemental Digital Appendix 2 at http://links.lww.com/ACADMED/B430).…”

“…Systems-based practice entails the “awareness of and responsiveness to the larger context and system of health care … as well as the ability to call effectively on other resources to provide optimal health care.” 1 Thirteen articles (15%) clustered within this competency, covering 2 themes: continuity of care (12 articles) and panel size (1 article). Continuity of care is important to multiple stakeholders as a driver of patient outcomes, patient satisfaction, physician satisfaction, and trainee education 17,52–62 ; however, it is variably defined. 93 Articles from primary care specialties defined continuity either from the physician perspective (proportion of visits with “my patients”) 52,53,55–57,59,60,62 or from the patient perspective (proportion of visits with “my doctor”), 17,54,61 using EHR-recorded relationships.…”

“…Two articles followed up investigations of continuity with interventions designed to improve continuity and decrease variation among trainees. 52,60 Panel size was a second, related theme. Kronzer et al 63 found that trainee gender and surname contributed to disparate trainee panel sizes, underscoring that trainee educational opportunities may be affected by systemic bias.…”

The Financial Cost of Interprofessional Ambulatory Training: What's the Bottom Line?

“…Care coordination facilitated by the work of the patient access coordinator and extended hours may be responsible for this difference. 19 The patient access coordinator called patients to remind them of appointments, helped patients navigate transportation and logistical barriers, and opened acute slots when patients indicated the need to reschedule appointments.…”

Everybody Copes: An Interprofessional Workshop on Stress, Coping, and Helping Primary Care Patients Manage Medical Stressors

“…As part of the program, four to five workshops are conducted annually and include at least one behavioral health topic each year. Workshop participants included primary care faculty, the project's dedicated patient access coordinator, 18 and trainees from medicine (internal medicine residents and medical students), physician assistant, and pharmacy training programs. Author Caroline F. Z. Stuhlmann was the current psychology trainee in the IMPACcT program and was asked to lead the development and implementation of this curriculum.…”