title: Acute Care Utilization by Patients After Graduation of Their Resident Primary Care Physicians.
abstract: BACKGROUND
  The disruption in provider continuity caused by medical resident graduation may result in adverse patient outcomes.
  
  
  OBJECTIVE
  Our aim was to investigate whether resident graduation was associated with increased acute care utilization by residents' primary care patients.
  
  
  METHODS
  This was a retrospective cohort study of patients cared for by junior and senior residents finishing the academic year in 2010, 2011 and 2012.
  
  
  METHODS
  We compared rates of clinic visits, emergency department (ED) visits, and hospitalizations between transitioning patients whose residents were graduating and non-transitioning patients whose residents were not graduating.
  
  
  RESULTS
  Our study population comprised 90 residents, 4018 unique patients, and 5988 resident-patient dyads that transitioned (n = 3136) or did not transition (n = 2852). For transitioning patients, the clinic visit rate per 100 patients in the 4 months before and after graduation was 129 and 102, respectively; for non-transitioning patients, the clinic visit rate was 119 and 94, respectively (difference-in-differences, +2 per 100 patients; p = 0.12). For transitioning patients, the ED visit rate per 100 patients before and after graduation was 29 and 26, respectively; for non-transitioning patients, the ED visit rate was 28 and 25, respectively (difference-in-differences, 0; p = 0.49). For transitioning patients, the hospitalization rate per 100 patients before and after graduation was 14 and 13, respectively; for non-transitioning patients, the hospitalization rate was 15 and 12, respectively (difference-in-differences, -2; p = 0.20). In multivariable modeling there was no increased risk for transitioning patients for clinic visits (adjusted rate ratio [aRR], 1.03; 95 % confidence interval [CI], 0.97 to 1.10), ED visits (aRR, 1.05; 95 % CI, 0.92 to 1.20), or hospitalizations (aRR, 1.04; 95 % CI, 0.83 to 1.31).
  
  
  CONCLUSIONS
  Acute care utilization by residents' patients did not increase or decrease after graduation. Acute care utilization was high before and after graduation. Interventions to decrease the need for acute care should be employed throughout the year.
authors.affiliation: Division of General Internal Medicine & Primary Care, Brigham and Women's Hospital, 1620 Tremont Street, BC-3, Boston, MA, 02120, USA. ssolomon5@partners.org.|Harvard Medical School, 1620 Tremont Street, BC-3, Boston, MA, 02120, USA. ssolomon5@partners.org.
authors.forename: Sonja R
authors.initials: SR
authors.lastname: Solomon
authors.affiliation: Harvard Medical School, 1620 Tremont Street, BC-3, Boston, MA, 02120, USA.|Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, 1620 Tremont Street, BC-3, Boston, MA, 02120, USA.
authors.forename: Holly C
authors.initials: HC
authors.lastname: Gooding
authors.affiliation: Division of General Internal Medicine & Primary Care, Brigham and Women's Hospital, 1620 Tremont Street, BC-3, Boston, MA, 02120, USA.|Harvard Medical School, 1620 Tremont Street, BC-3, Boston, MA, 02120, USA.
authors.forename: Harry
authors.initials: H
authors.lastname: Reyes Nieva
authors.affiliation: Division of General Internal Medicine & Primary Care, Brigham and Women's Hospital, 1620 Tremont Street, BC-3, Boston, MA, 02120, USA.|Harvard Medical School, 1620 Tremont Street, BC-3, Boston, MA, 02120, USA.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Linder
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D003266:Continuity of Patient Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D004503:Education, Medical, Graduate; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006302:Health Services Research / Q000379:methods; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D010360:Patient Transfer / Q000458:organization & administration / Q000706:statistics & numerical data; D010563:Personnel Turnover / Q000706:statistics & numerical data; D058007:Physicians, Primary Care / Q000193:education*; D011320:Primary Health Care / Q000458:organization & administration; D012189:Retrospective Studies
keywords: ambulatory care; care transitions; continuity of care; medical education-graduate; medical education-systems based practice; utilization