Provider Practice Characteristics That Promote Interpersonal Continuity

Abstract

Purpose: Becoming certified as a patient-centered medical home now requires practices to measure how effectively they provide continuity of care. To understand how continuity can be improved, we studied the association between provider practice characteristics and interpersonal continuity using the Usual Provider Continuity Index (UPC).Methods: We conducted a mixed-methods study of the relationship between provider practice characteristics and UPC in 4 university-based family medicine clinics. For the quantitative part of the study, we analyzed data extracted from monthly provider performance reports for 63 primary care providers (PCPs) between July 2009 and June 2010. We tested the association of 5 practice parameters on UPC:(1) clinic frequency; (2) panel size; (3) patient load (ratio of panel size to clinic frequency); (4) attendance ratio; and (5) duration in practice (number of years working in the current practice). Clinic, care team, provider sex, and provider type (physicians versus nonphysician providers) were analyzed as covariates. Simple and multiple linear regressions were used for statistical modeling. Findings from the quantitative part of the study were validated using qualitative data from provider focus groups that were analyzed using sequential thematic coding.Results: There were strong linear associations between UPC and both clinic frequency (␤ ‫؍‬ 0.94; 95% CI, 0.62-1.27) and patient load (␤ ‫؍‬ ؊0.37; 95% CI, ؊0.48 to ؊0.26). A multiple linear regression including clinic frequency, patient load, duration in practice, and provider type explained more than 60% of the variation in UPC (adjusted R 2 ‫؍‬ 0.629). UPC for nurse practitioners and physician assistants was more strongly dependent on clinic frequency and was at least as high as it was for physicians. Focus groups identified 6 themes as other potential sources of variability in UPC.Conclusions: Variability in UPC between providers is strongly correlated with variables that can be modified by practice managers. Our study suggests that patients assigned to nurse practitioners and physician assistants have continuity similar to those assigned to physicians. (J Am Board Fam Med 2013; 26:356 -365.)

Continuity of Care in Resident Outpatient Clinics: A Scoping Review of the Literature

“…In continuity studies that do not focus on trainees, UPC ranges from 63 to 78 in recent publications. [56][57][58] Despite significant variability in studies across clinic settings, geographic location, and patient populations, resident continuity is consistently lower compared with that of physicians in practice. 47,50,54 When parsed specifically, time in clinic and panel size seem to have the most impact on resident-patient continuity.…”

Common Illnesses, Patient Physician Interactions, Continuity, and Practice Organization

“…By looking at the factors associated with such continuity, Saultz et al 2 provide valuable details extending typically expected results (such as the frequency of being in the office) to other specific results that could help offices improve their patient-provider continuity in the ambulatory care office setting. For example, the authors assess continuity by numbers of patients compared with session frequency, and the comparisons extend to associated mid-level providers.…”

Effect of Named, Accountable GPs on Continuity of Care: Protocol for a Regression Discontinuity Study of a National Policy Change

“…Many evaluative studies of the effect of interventions aimed at greater continuity of care have been conducted within specific localities, which can limit the generalizability of study findings [41617212223]. However, in 2014, the Department of Health reformed the contract for general practices in England to require that all patients aged 75 or over be appointed a named general practitioner with specific responsibilities for care coordination [24].…”