Abstract
Achieving patient continuity in resident continuity clinic is challenging. Patients, residents and primary care providers (PCP) benefit from this ongoing relationship. We examined rates of continuity of infant well care for first year pediatric residents (PL1) and associated factors in three clinics (W, E and K) in a community health center system. We collected the number of infants who had PL1 PCPs for academic years 2010, 2011 and 2012 and patient demographic data. We measured continuity using the usual provider of care method. We assessed rates of continuity, total numbers of infants and factors associated with continuity and medical home by Chi Square, ANOVA, Student’s t test and multivariate linear regression (SPSS version 21). 115 patients had a PL1 PCP and attended 408 visits with 19 residents. The mean number of infants seen per PL1 in each clinic was W 7.8 ± 2.2, E 3.8 ± 1.5 and K 3.7 ± 2.9 (p < .01). PL1 continuity percentage was 66% at W, 47% at E and 54% at K (p < .01). Total continuity of care for all providers at W was 70%, E 65% and K 60% (p < .01 W vs. K only). In multivariate linear regression, only continuity of care for all providers was associated with mean PL1 continuity with β of 2.24 (95% CI 1.13–3.34), p < .001. PL1 continuity differed significantly between clinic sites. The only predictor of PL1 well care continuity was total clinic continuity of care. Maximizing continuity through the Medical Home practice was significantly associated with increased resident continuity of care.
Similar content being viewed by others
References
Saultz, J. W., & Albedaiwi, W. (2004). Interpersonal continuity of care and patient satisfaction: A critical review. The Annals of Family Medicine, 2(5), 445–451.
Pandhi, N., & Saultz, J. W. (2006). Patients’ perceptions of interpersonal continuity of care. Journal of the American Board of Family Medicine, 19(4), 390–397.
Hjortdahl, P., & Laerum, E. (1992). Continuity of care in general practice: Effect on patient satisfaction. The BMJ, 304(6837), 1287–1290.
Christakis, D. A., Wright, J. A., Zimmerman, F. J., Bassett, A. L., & Connell, F. A. (2002). Continuity of care is associated with high-quality care by parental report. Pediatrics, 109(4), e54.
Serwint, J. R. (2001). Multisite survey of pediatric residents’ continuity experiences: Their perceptions of the clinical and educational opportunities. Pediatrics, 107(5), e78.
Randall, C. S., Bergus, G. R., Schlechte, J. A., McGuinness, G., & Mueller, C. W. (1997). Factors associated with primary care residents’ satisfaction with their training. Family Medicine, 29(10), 730–735.
ACGME Program Requirements for Graduate Medical Education in Pediatrics. (2017) Retrieved from 14 Apr 2017 http://www.acgme.org/acgmeweb/Portals/0/PFAssets/ProgramRequirements/320_pediatrics_07012015.pdf.
Christakis, D. A., Mell, L., Koepsell, T. D., Zimmerman, F. J., & Connell, F. A. (2001). Association of lower continuity of care with greater risk of emergency department use and hospitalization in children. Pediatrics, 107(3), 524–529.
Christakis, D. A., Mell, L., Wright, J. A., Davis, R., & Connell, F. A. (2000). The association between greater continuity of care and timely measles-mumps-rubella vaccination. American Journal of Public Health, 90(6), 962–965.
Christakis, D. A., Feudtner, C., Pihoker, C., & Connell, F. A. (2001). Continuity and quality of care for children with diabetes who are covered by Medicaid. Ambulatory Pediatrics, 1(2), 99–103.
Love, M. M., Mainous, A. G. 3rd, Talbert, J. C., & Hager, G. L. (2000). Continuity of care and the physician-patient relationship: The importance of continuity for adult patients with asthma. The Journal of Family Practice, 49(11), 998–1004.
Christakis, D. A., Wright, J. A., Zimmerman, F. J., Bassett, A. L., & Connell, F. A. (2003). Continuity of care is associated with well-coordinated care. Ambulatory Pediatrics, 3(2), 82–86.
Bowen, J. L., Hirsh, D., Aagaard, E., Kaminetzky, C. P., Smith, M., Hardman, J., et al. (2015). Advancing educational continuity in primary care residencies: An opportunity for patient-centered medical homes. Academic Medicine, 90(5), 587–593.
Academic Pediatric Association. Manual for pediatric continuity directors (2017) Retrieved from 8 May 2017 https://www.academicpeds.org/specialInterestGroups/pdfs/ContinuityClinicManual.pdf.
Neher, J. O., Kelsberg, G., & Oliveira, D. (2001). Improving continuity by increasing clinic frequency in a residency setting. Family Medicine, 33(10), 751–755.
Diao, K., Tripodis, Y., Long, W. E., & Garg, A. (2017). Socioeconomic and racial disparities in parental perception and experience of having a medical home, 2007 to 2011-12. Academic Pediatrics, 17(1), 95–103.
Sugarman, J. R., Phillips, K. E., Wagner, E. H., Coleman, K., & Abrams, M. K. (2014). The safety net medical home initiative: Transforming care for vulnerable populations. Medical Care, 52(11 Suppl 4), S1–S10.
Gabow, P., Eisert, S., & Wright, R. (2003). Denver Health: A model for the integration of a public hospital and community health centers. Annals of Internal Medicine, 138(2), 143–149.
Gabow, P. (2016). Closing the health care gap in communities: A safety net system approach. Academic Medicine, 91(10), 1337–1340.
Darden, P. M., Ector, W., Mora, C., & Quattlebaum, T. G. (2001). Comparison of continuity in a resident versus private practice. Pediatrics, 108(6), 1263–1268.
Lerner, C. F., & Chung, P. J. (2010). Continuity of care in fixed-day versus variable-day resident continuity clinics. Academic Pediatrics, 10(2), 119–123.
McBurney, P. G., Moran, C. M., Ector, W. L., Quattlebaum, T. G., & Darden, P. M. (2004). Time in continuity clinic as a predictor of continuity of care for pediatric residents. Pediatrics, 114(4), 1023–1027.
American Academy of Pediatrics Medical Home Program Advisory Committee (2002) 2002 policy statement: The medical home. Pediatrics, 110, 184–186.
Osborn, L. M., Sargent, J. R., & Williams, S. D. (1993). Effects of time-in-clinic, clinic setting, and faculty supervision on the continuity clinic experience. Pediatrics, 91(6), 1089–1093.
Schumacher, D. J., Fritner, M. P., & Cull, W. (2016). Relationships between program size, training experience and career intentions: Pediatrics resident reports from 2010 to 2014. Academic Pediatrics, 16(7), 630–637.
Whalen, A. M., & Michelson, C. D. (2016). National trends in procedural training in pediatric residency. Academic Pediatrics, 16(6), e14.
Schumacher, D. J., & Frinter, M. P. (2016). Graduating pediatric resident training and comfort with ACGME required procedures. Academic Pediatrics, 16(6), e2.
Serwint, J. R., & Kumar, G. (1999). The effect of patient reassignment on future continuity in a pediatric resident continuity practice. The Archives of Pediatrics & Adolescent Medicine, 153(6), 581–585.
Acknowledgements
We would like to thank Rachel Everhart, PhD for collection of data from the Denver Health administrative data systems, Simon Hambidge, MD, PhD for review of the manuscript and the residents for their care of their patients and their desire to see their own patients. This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Varnell, H.G., O’Connor, M.E. Continuity of Infant Well Care in a Community Health Center Resident Clinic. J Community Health 44, 143–148 (2019). https://doi.org/10.1007/s10900-018-0564-3
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10900-018-0564-3