Journal of General Internal Medicine

, Volume 28, Issue 8, pp 999–1007

What Do Patients Think About Year-End Resident Continuity Clinic Handoffs?: A Qualitative Study

  • Amber T. Pincavage
  • Wei Wei Lee
  • Kimberly J. Beiting
  • Vineet M. Arora
Original Research

ABSTRACT

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 (81 % [68/84] vs. 53 % [10/19], p = 0.009) and report satisfaction with communication between their old and new doctors (80 % [67/84] vs. 58 % [11/19], p = 0.04). Patients reported positive experiences such as learning more about their new physician through personal sharing, which helped them build rapport. 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.

KEY WORDS

outpatient handoffs sign-out resident continuity clinic year-end transfer transitions of care patient-centered care patient safety 

Supplementary material

11606_2013_2395_MOESM1_ESM.pdf (123 kb)
ESM 1(PDF 122 kb)

REFERENCES

  1. 1.
    Young JQ, Wachter RM. Academic year-End transfers of outpatients from outgoing to incoming residents: an unaddressed patient safety issue. JAMA. 2009;302(12):1327–1329.PubMedCrossRefGoogle Scholar
  2. 2.
    Young JQ, Eisendrath SJ. Enhancing patient safety and resident education during the academic year-end transfer of outpatients: lessons from the suicide of a psychiatric patient. Acad Psych. 2011;35(1):54–57.CrossRefGoogle Scholar
  3. 3.
    Caines LC, Brockmeyer DM, Tess AV, Kim H, Kriegel G, Bates CK. The revolving door of resident continuity practice. Identifying gaps in transitions of care. J Gen Intern Med. 2011;6(9):995–998.CrossRefGoogle Scholar
  4. 4.
    Pincavage AT, Ratner S, Prochaska ML, Prochaska M, Oyler J, Davis AM, Arora V. Outcomes for resident-identified high-risk patients and resident perspectives of year-end continuity clinic handoffs. J Gen Intern Med. 2012;27(11):1438–1444.PubMedCrossRefGoogle Scholar
  5. 5.
    Accreditation Council for Graduate Medical Education. ACGME Program Requirements for Graduate Medical Education in Internal Medicine. Available at:http://www.acgme.org/acgmeweb/ProgramandInstitutionalGuidelines/MedicalAccreditation/InternalMedicine.aspx Accessed February 14, 2013.
  6. 6.
    Young JQ, Niehaus B, Lieu SC, O’Sullivan PS. Improving resident education and patient safety: a method to balance caseloads at academic year-end transfer. Acad Med. 2010;85(9):1418–1424.PubMedCrossRefGoogle Scholar
  7. 7.
    Young JQ, Pringle Z, Wachter RM. Improving follow-up of high risk psychiatry outpatients at resident year-end transfer. Jt Comm J Qual Patient Saf. 2011;37(7):300–308.PubMedGoogle Scholar
  8. 8.
    Donnelly MJ, Clauser JM, Weissman NJ. An intervention to improve ambulatory care handoffs at the end of residency. J Graduate Med Educ. 2012;4(3):381–384.CrossRefGoogle Scholar
  9. 9.
    Garment AR, Lee WW, Harris C, Phillips-Caesar E. Development of a structured year-end sign-out program in an outpatient continuity practice. J Gen Intern Med. 2012;28(1):114–120.PubMedCrossRefGoogle Scholar
  10. 10.
    Roy MJ, Kroenke K, Herbers JE Jr. When the physician leaves the patient: predictors of satisfaction with the transfer of primary care in a primary care clinic. J Gen Intern Med. 1995;10(4):206–210.PubMedCrossRefGoogle Scholar
  11. 11.
    Roy MJ, Herbers JE, Seidman A, Kroenke K. Improving patient satisfaction with the transfer of care, a randomized controlled trial. J Gen Intern Med. 2003;18(5):364–369.PubMedCrossRefGoogle Scholar
  12. 12.
    Agency for Healthcare Research and Quality and National Institute of Mental Health. Program announcement. Patient-centered care: customizing care to meet patients’ needs. 2001, July 31. Web site: http://grants.nih.gov/grants/guide/pa-files/PA-01-124.html. Accessed February 14, 2013.
  13. 13.
    Institute of Medicine (IOM). Committee on Health Care in America. Crossing the quality chasm: a new health system for the 21st century. National Academy Press: Institute of Medicine. 2001.Google Scholar
  14. 14.
    Weissman JS, Schneider EC, Weingart SN, Epstein AM, David-Kasdan J, Feibelmann S, Annas CL, Ridley N, Kirle L, Gatsonis C. Comparing patient-reported hospital adverse events with the medical record review: do patients know something that hospitals do not? Ann Intern Med. 2005;149(2):100–108.CrossRefGoogle Scholar
  15. 15.
    Weingart SN, Pagovich O, Sands DZ, Aronson MD, Davis RB, Bates DW, Phillips RS. What can hospitalized patients tell us about adverse events? Learning from the patient-reported incidents. J Gen Intern Med. 2005;20(9):830–836.PubMedCrossRefGoogle Scholar
  16. 16.
    Arora VM, Prochaska ML, Farnan JM, D'Arcy VMJ, Schwanz KJ, Vinci LM, Davis AM, Meltzer DO, Johnson JK. Problems after discharge and understanding of communication with their primary care physicians among hospitalized seniors: a mixed methods study. J Hosp Med. 2010;5(7):385–391.PubMedCrossRefGoogle Scholar
  17. 17.
    Pincavage AT, Ratner S, Lee WW, Oyler J, Arora VM. Innovating education to improve year-end resident continuity clinic handoffs. Acad Intern Med Insight. 2012;10(3):8–9, 11.Google Scholar
  18. 18.
    Coleman EA, Mahoney E, Parry C. Assessing the quality of preparation for post-hospital care from the Patient’s perspective: the care transitions measure. Med Care. 2005;43(3):246–255.PubMedCrossRefGoogle Scholar
  19. 19.
    Coleman EA, Smith JD, Eilertsen TB, Frank JC, Thiare JN, Ward A, and Kramer AM. Development and testing of a measure designed to assess the quality of care transitions. International Journal of Care Integration. 2002:2 April–June.Google Scholar
  20. 20.
    ATLAS.ti Qualitative Data Analysis Program. Scientific Software Development GambH. 2002–2013.Google Scholar
  21. 21.
    STATA 21 11.0 (College Station, TX).Google Scholar

Copyright information

© Society of General Internal Medicine 2013

Authors and Affiliations

  • Amber T. Pincavage
    • 1
  • Wei Wei Lee
    • 1
  • Kimberly J. Beiting
    • 2
  • Vineet M. Arora
    • 1
  1. 1.Department of MedicineUniversity of ChicagoChicagoUSA
  2. 2.University of Illinois at Chicago College of MedicineChicagoUSA

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