Associate Professor of Pediatrics Geisel School of Medicine at Dartmouth Lebanon, New Hampshire, United States
Background: Outpatient continuity clinic is a core requirement of pediatric residency accreditation. Continuity for patient care and education has been difficult to establish in residency clinics in a traditional model in which residents spend ½ day in clinic per week. Nationally, a cohort of residency programs have switched to an X+Y curriculum, whereby the X block includes rotations without continuity clinics and the Y block is dedicated to continuity clinics. Although literature has explored the impact on patient continuity, there has been no published measured data of the impact of the X+Y curriculum on pediatric continuity. Objective: To assess continuity as measured by two factors (patient sees PCP & PCP sees own patient) in a pediatric residency clinic and compare continuity before and after implementation of an X+Y format. Design/Methods: Two separate continuity measures have been aggregated by our institution as quality indicators. Patient continuity (patient sees PCP) is assessed at the individual provider level by determining the number of assigned “panel” patients seen by their PCP in the month, divided by the total number of panel patients seen in the practice that month. PCP continuity is assessed similarly by the number of “panel” patients seen by their PCP in the month, divided by the total number of patients seen by the PCP that month. Indicators were grouped into 6 month periods and assessed by each resident level to account for temporal variations in training and patient volumes. These indicators were compared to faculty at the residency continuity locations over the same time frames. One-way ANOVA were used to assess differences in proportions. Results: Patient continuity has significantly declined for residents since X+Y implementation. (Fig. 1) PCP continuity has declined in a statistically significant manner across all training levels for residents. (Fig 2) Both types of continuity (patient continuity & PCP continuity) measures for faculty have not been similarly impacted. (Fig. 1 & 2)
Conclusion(s): X+Y scheduling has decreased continuity measures in one small residency program. The decline in continuity has substantial impacts for patient care, patient satisfaction and resident education. Efforts are needed to determine root causes to improve continuity measures.
