title: Factors Associated With Resident Continuity in Ambulatory Training Practices.
abstract: BACKGROUND
  Continuity of care is a critical element of residents' educational experience in primary care programs.
  
  
  OBJECTIVE
  We examined how continuity in resident practices compares to nonteaching practices, identified factors associated with increased continuity, and explored the association between continuity and quality measures.
  
  
  METHODS
  We analyzed 117 235 patient visits to 4 resident practices (26 resident teams in internal medicine, pediatrics, family medicine, and medicine-pediatrics) and 270 242 visits to nonteaching community practices between July 2013 and May 2014. We defined continuity from both clinician and patient perspectives, and used logistic regression models to examine the influence of factors on continuity while controlling for postgraduate year, patient age, gender, race, and insurance.
  
  
  RESULTS
  Continuity was greater at nonteaching sites compared to resident practices (87.3% versus 56.2%,P< .001). Resident continuity ranged from 33.1% to 83.7% among resident sites. Factors associated with improved resident continuity included absence of advanced practice providers (71.5% versus 52.3%); consistent use of scheduling protocols (77.5% versus 33.1%); rescheduling policies (71.5% versus 41.3%); increased faculty clinical time (71.5% versus 46.3%); and dismissal policies for excessive missed appointments (71.5% versus 62.5%,P< .001 for all). Increased continuity was associated with improved rates of diabetic control (62.8% versus 54.6%); hypertension control (82.8% versus 57.5%); screening colonoscopy (69.2% versus 31.9%); and mammography (74.8% versus 38.2%,P< .001 for all).
  
  
  CONCLUSIONS
  Increased clinical faculty time, scheduling protocols, and absence of advanced practice providers were most strongly associated with increasing continuity. Increased continuity was associated with improved quality measures.
authors: Robert J
authors: RJ
authors: Fortuna
authors: Lynn
authors: L
authors: Garfunkel
authors: Michael D
authors: MD
authors: Mendoza
authors: Megan
authors: M
authors: Ditty
authors: Julia
authors: J
authors: West
authors: Karen
authors: K
authors: Nead
authors: Brett W
authors: BW
authors: Robbins
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000368:Aged; D000554:Ambulatory Care Facilities / Q000458:organization & administration*; D003266:Continuity of Patient Care / Q000706:statistics & numerical data*; D005194:Family Practice / Q000193:education; D005260:Female; D006801:Humans; D007388:Internal Medicine / Q000193:education; D007396:Internship and Residency / Q000458:organization & administration*; D008297:Male; D008875:Middle Aged; D009518:New York; D005791:Patient Care / Q000706:statistics & numerical data*; D010372:Pediatrics / Q000193:education; D055815:Young Adult