370 - Putting continuity back into resident continuity clinic: a QI approach

Poster Number: 370
Publication Number: 370.1917

Background: Outpatient patient-physician continuity is associated with improved health outcomes, patient satisfaction, and follow up care, and decreased costs and missed appointments. Resident continuity of care is also a predictor of resident satisfaction, and the ACGME requires continuous, long- term resident-patient relationships. Due to the complexities of resident scheduling, achieving high continuity of care in resident practices has been difficult, with rates ranging from 29-56% across specialties. Studies have described individual interventions to improve continuity but few, if any, have looked at the impact of a multi-disciplinary quality improvement (QI) bundle.

Objective: To describe the effect of a QI bundle on resident continuity rates

Design/Methods: This study took place at 4 resident-faculty practices that serve as continuity sites for 79 residents in Upper Manhattan. A fishbone diagram was created based on the primary drivers of continuity locally and in the literature (Figure 1) and key stakeholders identified. Areas for intervention were included in a change bundle (Figure 2). Continuity rates were calculated using published formulas ‘Usual Provider of Care’(UPC) and ‘Continuity for Physicians Formula’ (CPF)to identify the proportion of appointments a patient has with their primary physician and the proportion of appointments a physician has with their patients, respectively.

Results: Several years prior to the implementation of the change bundle, the CPF rates were measured at one of four sites as 53%. The change bundle was implemented in 2021-2022 following practice de-consolidation after the peak of the pandemic. As of December 2022, across the four sites resident UPC rates increased to 66 -68% and CPF ranged from 56 -70%. The faculty UPC and CPF were 73 -83% and 83- 90% respectively. When resident teams were included in the calculation, their rates approximated faculty rates for both. All rates have been sustained for 10 months (Figure 3).

Conclusion(s): The development of a QI bundle successfully resulted in sustained rates of provider-patient continuity above those reported in the literature. Implementing similar interventions may be a feasible method for programs to improve their resident-patient continuity. These improvements have the potential to improve patient outcomes and increase resident satisfaction. Since many of the most medically and socially complex patients are cared for in resident practices, which have traditionally had lower rates of continuity, these interventions can potentially address an important cause of structural inequity.