486 - Building the Infrastructure for Continuity of Patient Care for Residents: Empanelment is Key

Poster Number: 486
Publication Number: 486.3194

Background: Continuity of care is required for and critical to pediatric residency education. However, effective empanelment of patients in continuity clinic remains challenging.

Objective: To describe and validate empanelment of continuity clinic patients to pediatric residents.

Design/Methods: Eighteen months of visit data for patients < 21 years was pulled from the electronic health record (EHR) to use for assignment. Due to EHR limitations, assignment was external to the EHR. The 4-cut methodology, which empanels patients to the resident to whom they were most engaged, was used to assign patients to residents. Patients never seen by a current resident were randomly assigned to meet specialty and training level patient targets. Empanelment was validated using the published Continuity for Physician methodology using visits from 7/1/2022-6/30/2023 to lessen the effect of resident transition.

Results: Over 18 months, there were 18,742 visits from 9,930 unique patients (8,600 patients needed for empanelment) by 157 residents, 95 were current trainees (Table). Patients made an average of 1.9 visits (range of 1 to 17 visits). Mean current age was 6.6 (range 0 to 20 years). Empanelment used the 4-cut method, cut 1 was patients who had only seen one current resident (4,776, 54.9%), then cut 2, a majority of visits to one resident (324, 3.7%), cut 3, the resident who did the last well check (1,023, 11.8%), cut 4, the most recently seen resident (395, 4.5%), total of 6,518 (75%) assigned; last was randomized assignment of patients to meet their specialty and training level targets, 2,180 (25%). A total of 8,698 were empaneled. In 18 months, most residents had not seen enough unique patients for empanelment. Nine Pediatric residents had seen sufficient patients for complete empanelment, 1 of 25 PGY2 and 8 of 24 PGY3. Other residents, including Medicine Pediatrics and Child Neurology/Pediatric required random assignment of patients. Validating the empanelment, Continuity for Physician was greater for Pediatrics versus Medicine/Pediatrics, for 3rd versus 2nd year residents and the interaction between service and level of training was significant (Table, P< 0.03).

Conclusion(s): The 4-step method is effective in empaneling patients. Panels of patients for residents, a necessity for improving continuity of care, should reflect patients the resident has cared for. Further improvement should prioritize scheduling patients with their assigned resident. Future work will explore the significant differences in engagement and continuity of care between residents which could result in generalizable activities for improving continuity.