Outcomes for resident-identified high-risk patients and resident perspectives of year-end continuity clinic handoffs.
BACKGROUND
Many patients nationwide change their primary care physician (PCP) when internal medicine (IM) residents graduate. Few studies have examined this handoff.


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


METHODS
Retrospective cohort


METHODS
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Department of Medicine, University of Chicago, Chicago, IL 60637, USA. apincava@medicine.bsd.uchicago.edu
Amber T
AT
Pincavage
Shana
S
Ratner
Megan L
ML
Prochaska
Meryl
M
Prochaska
Julie
J
Oyler
Andrew M
AM
Davis
Vineet M
VM
Arora
D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007388:Internal Medicine; D007396:Internship and Residency; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D062209:Patient Handoff / Q000706:statistics & numerical data*; D010361:Patients; D058007:Physicians, Primary Care; D012189:Retrospective Studies; D012306:Risk