title: Change in Residents' Experience in Continuity Clinic After Patient-Focused Primary Care Redesign.
abstract: Evaluation of efforts to redesign primary care has primarily focused on clinical services, with limited assessment of the effect on learners. This study evaluated the change in pediatric residents' perception of training, teamwork, and patient care in 2 different continuity clinic settings that were implementing patient-focused primary care redesign.
  
  
  
  Continuity clinic residents at 2 large urban pediatric training programs completed a survey, developed de novo, before and after primary care redesign. Differences in the proportion of positive (≥4 of 5) ratings before and after redesign were compared using chi-squared tests in 2 practice sites, each of which focused on improving specific aspects of their practice.
  
  
  
  The response rate was >70% in both sites and in both years. Residents in the site focused on teamwork and continuity were more likely to report improved teamwork training (64% vs 83%; P < .05) and teamwork among residents (82% vs 98%; P < .05) after redesign. Perception of overall quality of care in clinic also improved (47% vs 68%; P < .05). Residents in the site focused on clinic flow were more likely to report that physicians, nurses, and administrative staff worked together to optimize patient flow after redesign (25% vs 48%; P < .05). No improvements were seen in domains without focused interventions in either site.
  
  
  
  Practice redesign focused on clinical outcomes can positively affect resident perception of their training and clinical experience in continuity clinic. Future redesign efforts deliberately involving residents might further enhance continuity clinic training.
authors.affiliation: Penn State College of Medicine, Department of Pediatrics, Hershey, Penn. Electronic address: bfogel@hmc.psu.edu.
authors.forename: Benjamin N
authors.initials: BN
authors.lastname: Fogel
authors.affiliation: Cincinnati Children's Hospital Medical Center, Division of General and Community Pediatrics, Cincinnati, Ohio.
authors.forename: Stephen
authors.initials: S
authors.lastname: Warrick
authors.affiliation: Division of General Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Mass.
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Finkelstein
authors.affiliation: Cincinnati Children's Hospital Medical Center, Division of General and Community Pediatrics, Cincinnati, Ohio.
authors.forename: Melissa
authors.initials: M
authors.lastname: Klein
mesh_terms: D000328:Adult; D000553:Ambulatory Care; D001291:Attitude of Health Personnel; D003266:Continuity of Patient Care; D003299:Cooperative Behavior; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008297:Male; D018802:Patient-Centered Care; D010372:Pediatrics / Q000193:education*; D011320:Primary Health Care; D058996:Quality Improvement; D011787:Quality of Health Care; D055815:Young Adult
keywords: continuity clinic; primary care; quality improvement; redesign; resident education