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Improving Continuity by Increasing Clinic Frequency in a Residency Setting

机译：在住院期间通过增加门诊频率来改善连续性

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BACKGROUND AND OBJECTIVES: Continuity of care is required in family practice training programs. However, continuity for some patients may not be adequately served in the traditional training model that has residents in the family practice center (FPC) for 1 to 3 half-day clinics per week. This study sought to determine if increasing clinic frequency in a family practice residency has an effect on continuity of care. METHODS: On January 1, 1999, the residency program changed from a traditional clinic scheduling model to one where all residents saw patients in the FPC 4 to 5 days a week. By using shorter clinic sessions, total resident time in the FPC was nearly unchanged (decreasing 5% overall). We reviewed 1,709 randomly selected billing records for residents' patients who frequently utilized medical care (three or more visits within 6 months) and assessed continuity for 1 year before and after this intervention, using both the modified, modified continuity index (MMCI) and the percentage of visits to the primary care provider (PCP). RESULTS: Overall, the MMCI for patients who frequently saw residents increased from .59 to .64. The average frequency with which these patients saw their PCPs improved for the first-year class (from 51% of visits before implementation to 72% after) and the third-year class (from 66% of visits to 72%). CONCLUSIONS: Scheduling daily resident clinics in the FPC increased continuity among patients who frequently saw residents beyond that achieved using traditional scheduling, without increasing total resident time in the FPC.
机译：背景和目的：家庭实践培训计划中需要持续的护理。但是，在传统的训练模式下，某些患者的连续性可能无法得到充分满足，传统的训练模式是每周在家庭实践中心（FPC）居住1至3个半天诊所。这项研究试图确定家庭执业居民中增加临床频率是否对护理的连续性有影响。方法：1999年1月1日，住院医师程序从传统的诊所调度模式更改为所有居民每周4至5天在FPC中看到病人的程序。通过缩短诊疗时间，FPC的总住院时间几乎没有变化（总体减少了5％）。我们对经常使用医疗服务的居民患者（在6个月内进行了3次或更多次就诊）随机审查了1,709项计费记录，并使用修改后的修改后的连续性指数（MMCI）和访问初级保健提供者（PCP）的百分比。结果：总体而言，经常看到居民的患者的MMCI从.59增加到.64。在第一年级（从实施前就诊的51％到实施后的72％）和第三年级（从就诊率的66％到72％），这些患者看到其PCP的平均频率有所提高。结论：在FPC中安排日常住院门诊可以增加经常看到住院病人的患者的连续性，而这些情况超出了使用传统调度所能达到的水平，而没有增加FPC的总住院时间。

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