title: Clinic Design and Continuity in Internal Medicine Resident Clinics: Findings of the Educational Innovations Project Ambulatory Collaborative.
abstract: BACKGROUND
  Many internal medicine (IM) programs have reorganized their resident continuity clinics to improve trainees' ambulatory experience. Downstream effects on continuity of care and other clinical and educational metrics are unclear.
  
  
  METHODS
  This multi-institutional, cross-sectional study included 713 IM residents from 12 programs. Continuity was measured using the usual provider of care method (UPC) and the continuity for physician method (PHY). Three clinic models (traditional, block, and combination) were compared using analysis of covariance. Multivariable linear regression analysis was used to analyze the effect of practice metrics and clinic model on continuity.
  
  
  RESULTS
  UPC, reflecting continuity from the patient perspective, was significantly different, and was highest in the block model, midrange in combination model, and lowest in the traditional model programs. PHY, reflecting continuity from the perspective of the resident provider, was significantly lower in the block model than in combination and traditional programs. Panel size, ambulatory workload, utilization, number of clinics attended in the study period, and clinic model together accounted for 62% of the variation found in UPC and 26% of the variation found in PHY.
  
  
  CONCLUSIONS
  Clinic model appeared to have a significant effect on continuity measured from both the patient and resident perspectives. Continuity requires balance between provider availability and demand for services. Optimizing this balance to maximize resident education, and the health of the population served, will require consideration of relevant local factors and priorities in addition to the clinic model.
authors.forename: Maureen D
authors.initials: MD
authors.lastname: Francis
authors.forename: Mark L
authors.initials: ML
authors.lastname: Wieland
authors.forename: Sean
authors.initials: S
authors.lastname: Drake
authors.forename: Keri Lyn
authors.initials: KL
authors.lastname: Gwisdalla
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Julian
authors.forename: Christopher
authors.initials: C
authors.lastname: Nabors
authors.forename: Anne
authors.initials: A
authors.lastname: Pereira
authors.forename: Michael
authors.initials: M
authors.lastname: Rosenblum
authors.forename: Amy
authors.initials: A
authors.lastname: Smith
authors.forename: David
authors.initials: D
authors.lastname: Sweet
authors.forename: Kris
authors.initials: K
authors.lastname: Thomas
authors.forename: Andrew
authors.initials: A
authors.lastname: Varney
authors.forename: Eric
authors.initials: E
authors.lastname: Warm
authors.forename: David
authors.initials: D
authors.lastname: Wininger
authors.forename: Mark L
authors.initials: ML
authors.lastname: Francis
mesh_terms: D000553:Ambulatory Care / Q000639:trends*; D000554:Ambulatory Care Facilities / Q000639:trends*; D003266:Continuity of Patient Care; D003430:Cross-Sectional Studies; D004059:Diffusion of Innovation; D004503:Education, Medical, Graduate / Q000639:trends*; D005160:Facility Design and Construction; D005260:Female; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency; D008297:Male; D017145:Models, Educational; D014481:United States; D016526:Workload