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.
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: Mohan Nadkarni; Siddharta Reddy; Carol K Bates; Blair Fosburgh; Stewart Babbott; Eric Holmboe Journal: J Gen Intern Med Date: 2010-07-14 Impact factor: 5.128
Authors: Maureen D Francis; Kris Thomas; Michael Langan; Amy Smith; Sean Drake; Keri Lyn Gwisdalla; Ronald R Jones; Katherine A Julian; Christopher Nabors; Anne Pereira; Michael Rosenblum; Andrew Varney; Eric Warm; Melchor Ortiz Journal: J Grad Med Educ Date: 2014-06
Authors: Mark L Wieland; Andrew J Halvorsen; Rajeev Chaudhry; Darcy A Reed; Furman S McDonald; Kris G Thomas Journal: J Gen Intern Med Date: 2013-08 Impact factor: 5.128
Authors: Maureen D Francis; Katherine A Julian; David A Wininger; Sean Drake; KeriLyn Bollman; Christopher Nabors; Anne Pereira; Michael Rosenblum; Amy B Zelenski; David Sweet; Kris Thomas; Andrew Varney; Eric Warm; Mark L Francis Journal: J Grad Med Educ Date: 2016-02
Authors: Andrew Coyle; Ira Helenius; Christina M Cruz; E Allison Lyons; Natalie May; John Andrilli; M Merav Bannet; Rachel Pinotti; David C Thomas Journal: J Grad Med Educ Date: 2019-04
Authors: Halle G Sobel; Rachel Swigris; Karen M Chacko; Alison Landrey; Monica McNulty; Kaitlyn Vennard; Susan Michelle Nikels; Kathleen Suddarth; Edward N Murphy; Eva Aagaard Journal: J Grad Med Educ Date: 2017-08