Improving continuity by increasing clinic frequency in a residency setting.
OBJECTIVE
Continuity of care is required in family practice training programs. However, continuity for some patients may not be adequately served in the traditional training model that has residents in the family practice center (FPC) for 1 to 3 half-day clinics per week. This study sought to determine if increasing clinic frequency in a family practice residency has an effect on continuity of care.


METHODS
On January 1, 1999, the residency program changedfrom a traditional clinic scheduling model to one where all residents saw patients in the FPC 4 to 5 days a week. By using shorter clinic sessions, total resident time in the FPC was nearly unchanged (decreasing 5% overall). We reviewed 1,709 randomly selected billing records for residents' patients who frequently utilized medical care (three or more visits within 6 months) and assessed continuity for 1 year before and after this intervention, using both the modified, modified continuity index (MMCI) and the percentage of visits to the primary care provider (PCP).


RESULTS
Overall, the MMCIfor patients who frequently saw residents increasedfrom .59 to .64. The average frequency with which these patients saw their PCPs improvedfor the first-year class (from 51% of visits before implementation to 72% after) and the third-year class (from 66% of visits to 72%).


CONCLUSIONS
Scheduling daily resident clinics in the FPC increased continuity among patients who frequently saw residents beyond that achieved using traditional scheduling, without increasing total resident time in the FPC.
Neher
J O
JO
Valley Medical Center Family Practice Residency, Renton, Wash 98055, USA. jneher@vmc.fammed.washington.edu
Kelsberg
G
G
Oliveira
D
D
D000328:Adult; D001071:Appointments and Schedules; D002983:Clinical Competence; D003266:Continuity of Patient Care / Q000592:standards*; D004503:Education, Medical, Graduate / Q000592:standards* / Q000639:trends; D004521:Educational Measurement; D005194:Family Practice / Q000193:education*; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000458:organization & administration*; D008297:Male; D009819:Office Visits / Q000706:statistics & numerical data; D015397:Program Evaluation