Ambulatory office organization for internal medicine resident medical education.
OBJECTIVE
Residents will most effectively learn about ambulatory, systems-based practice by working in highly functional ambulatory practices; however, systems experiences in ambulatory training are thought to be highly variable. The authors sought to determine the prevalence of functional-practice characteristics at clinics where residents learn.


METHODS
In 2007, the authors conducted a national survey of medical directors of resident continuity clinics using a comprehensive, Web-based instrument that included both a residency clinic assessment and a practice system assessment (PSA). The authors designed the PSA to estimate the Physician Practice Connections (PPC) score, indicating the readiness of a practice to function as a patient-centered medical home (PCMH).


RESULTS
Of 356 clinic directors or physician representatives responding to an initial inquiry, 221 completed the survey (62%)--representing 185 programs (49% of accredited programs). The majority of clinics were hospital based (139/220; 63%) or hospital supported (41/220; 19%) and were located in urban settings (151/217; 70%). Estimated payer mix categories included Medicare or managed Medicare (169; 29%), Medicaid or managed Medicaid (161; 34%), and self-pay (156; 25%). The mean estimated PPC score was 53 points (of 100; SD = 17.6). Suburban and rural clinics, Veterans Affairs' clinics, federally qualified health centers, and clinics with a higher proportion of patients with commercial insurance or managed Medicare earned higher scores.


CONCLUSIONS
A substantial portion of residency clinics have elements needed for PCMH recognition. However, clinics struggled with connecting these elements with coordination-of-care processes, suggesting areas for improvement to support better functioning of ambulatory training practices.
Babbott
Stewart F
SF
Division of General and Geriatric Medicine, Department of Medicine, University of Kansas, Kansas City, Kansas 66160, USA. sbabbott@kumc.edu
Beasley
Brent W
BW
Reddy
Siddharta
S
Duffy
F Daniel
FD
Nadkarni
Mohan
M
Holmboe
Eric S
ES
D000553:Ambulatory Care / Q000458:organization & administration*; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency / Q000592:standards*; D013038:Specialization; D014481:United States