Journal of General Internal Medicine

, Volume 27, Issue 11, pp 1438–1444

Outcomes for Resident-Identified High-Risk Patients and Resident Perspectives of Year-End Continuity Clinic Handoffs


    • Department of MedicineUniversity of Chicago
  • Shana Ratner
    • Division of General Medicine and EpidemiologyUniversity of North Carolina
  • Megan L. Prochaska
    • Internal Medicine Residency ProgramUniversity of Chicago
  • Meryl Prochaska
    • School of LawLoyola University
  • Julie Oyler
    • Department of MedicineUniversity of Chicago
  • Andrew M. Davis
    • Department of MedicineUniversity of Chicago
  • Vineet M. Arora
    • Department of MedicineUniversity of Chicago
Original Research

DOI: 10.1007/s11606-012-2100-y

Cite this article as:
Pincavage, A.T., Ratner, S., Prochaska, M.L. et al. J GEN INTERN MED (2012) 27: 1438. doi:10.1007/s11606-012-2100-y



Many patients nationwide change their primary care physician (PCP) when internal medicine (IM) residents graduate. Few studies have examined this handoff.


To assess patient outcomes and resident perspectives after the year-end continuity clinic handoff


Retrospective cohort


Patients who underwent a year-end clinic handoff in July 2010 and a comparison group of all other resident clinic patients from 2009–2011. PGY2 IM residents surveyed from 2010–2011.


Percent of high-risk patients after the clinic handoff scheduled for an appointment, who saw their assigned PCP, lost to follow-up, or had an acute visit (ED or hospitalization). Perceptions of PGY2 IM residents surveyed after receiving a clinic handoff.


Thirty graduating residents identified 258 high-risk patients. While nearly all patients (97 %) were scheduled, 29 % missed or cancelled their first new PCP visit. Only 44 % of patients saw the correct PCP and six months later, one-fifth were lost to follow-up. Patients not seen by a new PCP after the handoff were less likely to have appropriate follow-up for pending tests (0 % vs. 63 %, P < 0.001). A higher mean no show rate (NSR) was observed among patients who missed their first new PCP visit (22 % vs. 16 % NSR, p < 0.001) and those lost to follow-up (21 % vs. 17 % NSR, p = 0.019). While 47 % of residents worried about missing important data during the handoff, 47 % reported that they do not perceive patients as “theirs” until they are seen by them in clinic.


While most patients were scheduled for appointments after a clinic handoff, many did not see the correct resident and one-fifth were lost to follow-up. Patients who miss appointments are especially at risk of poor clinic handoff outcomes. Future efforts should improve patient attendance to their first new PCP visit and increase PCP ownership.


outpatient handoffssignoutresident continuity clinicyear-end transfertransitions of care

Supplementary material

11606_2012_2100_MOESM1_ESM.pdf (70 kb)
ESM 1(PDF 69 kb)

Copyright information

© Society of General Internal Medicine 2012