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首页> 外文期刊>Family medicine >The Importance of and the Complexities Associated With Measuring Continuity of Care During Resident Training: Possible Solutions Do Exist
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The Importance of and the Complexities Associated With Measuring Continuity of Care During Resident Training: Possible Solutions Do Exist

机译：住院医师培训期间衡量护理连续性的重要性和复杂性：存在可行的解决方案

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Background and Objectives: Evolutions in care delivery toward the patient-centered medical home have influenced important aspects of care continuity. Primary responsibility for a panel of continuity patients is a foundational requirement in family medicine residencies. In this paper we characterize challenges in measuring continuity of care in residency training in this new era of primary care.Methods: We synthesized the literature and analyzed information from key informant interviews and group discussions with residency faculty and staff to identify the challenges and possible solutions for measuring continuity of care during family medicine training. We specifically focused on measuring interpersonal continuity at the patient level, resident level, and health care team level.Results: Challenges identified in accurately measuring interpersonal continuity of care during residency training include: (1) variability in empanelment approaches for all patients, (2) scheduling complexity in different types of visits, (3) variability in ability to attain continuity counts at the level of the resident, and (4) shifting make-up of health care teams, especially in residency training. Possible solutions for each challenge are presented. Philosophical issues related to continuity are discussed, including whether true continuity can be achieved during residency training and whether qualitative rather than quantitative measures of continuity are better suited to residencies.Conclusions: Measuring continuity of care in residency training is challenging but possible, though improvements in precision and assessment of the comprehensive nature of the relationships are needed. Definitions of continuity during training and the role continuity measurement plays in residency need further study.(Fam Med 2016;48(4):286-93.)The physician-patient relationship is an essential feature of family medicine,1 and continuity of care has been shown to positively influence patients’ health outcomes and their satisfaction.2-6 While in 1983 the American Academy of Family Physicians defined continuity of care as “the process by which the patient and the physician are cooperatively involved in ongoing health care management toward the goal of high-quality, cost-effective medical care,”7 the literature proposes many definitions of continuity of care, which poses a challenge for researching this topic.8 For example, informational continuity refers to the availability of accurate information from one health care encounter to another, longitudinal continuity refers to a pattern of health care utilization at a specific site of care, and interpersonal continuity refers to a particular clinician-patient relationship characterized by loyalty and trust.8Interpersonal continuity is a feature that is especially important in family medicine as it recognizes the role of the physician-patient relationship in health and satisfaction.9 A core feature of interpersonal continuity is strong communication10 that develops during residency supported by an intentional curriculum.11 This concept was reaffirmed by the Future of Family Medicine Report,12 which underscored patients’ strong desire for a personal physician who knew them and who would take into account their own individual culture and value systems in that relationship. Unfortunately, interpersonal continuity is not well characterized from a measurement perspective.8 In 2003, Saultz additionally characterized interdisciplinary or team-based continuity as care that allows previous knowledge of the patient to be available when the patient requires a range of services spanning the medical specialties.8 An essential feature of all these types of continuity is the relationship between a patient and physician that includes personal and medical information about that patient, a shared location, and knowledge of the contextual features behind this physician-patient relationship.Evolutions in care delivery in patient-centered medical h
机译：背景与目标：向以患者为中心的医疗之家的护理交付方式的演变已经影响了护理连续性的重要方面。一组连续性患者的主要责任是家庭医学住院医师的基本要求。在本文中，我们描述了在这个新的初级保健时代中，在衡量住院医师培训连续性方面的挑战的特征。方法：我们综合了文献并分析了主要知情人士访谈和与住院医师和员工进行的小组讨论中的信息，以识别挑战和可能的解决方案用于测量家庭医学培训期间护理的连续性。结果：在住院医师培训期间准确测量人际护理连续性所面临的挑战包括：（1）所有患者的就诊方法存在差异，（2 ）安排不同类型就诊的复杂性，（3）在居民级别获得连续性计数的能力方面的差异，以及（4）改变医疗团队的组成，尤其是在住院医师培训中。提出了每种挑战的可能解决方案。讨论了与连续性相关的哲学问题，包括在住院医师培训期间是否可以实现真正的连续性，以及定性而不是定量的连续性指标是否更适合居民。结论：在住院医师培训中衡量护理的连续性虽然具有挑战性，但有可能实现，尽管需要精确和评估关系的综合性质。培训期间连续性的定义以及连续性测量在住院医师中的作用需要进一步研究。（Fam Med 2016; 48（4）：286-93。）医患关系是家庭医学的基本特征，1和护理的连续性2-6年，美国家庭医师学会在1983年将护理的连续性定义为“患者和医师合作参与正在进行的医疗保健管理的过程。高质量的，具有成本效益的医疗保健目标”，7文献提出了医疗保健连续性的许多定义，这对研究该主题提出了挑战。8例如，信息连续性是指从一种健康中获得准确的信息另一个人的护理遭遇，纵向连续性是指在特定护理地点利用卫生保健的一种模式，而人际连续性是指特定的以忠诚和信任为特征的临床医患关系。8人际连续性在家庭医学中尤为重要，因为它认识到医患关系在健康和满意度中的作用。9人际连续性的一个核心特征是强大的沟通能力10， 11未来家庭医学报告12重申了这一概念，该概念强调了患者对认识自己并考虑到自己的个人文化和价值体系的私人医生的强烈渴望。这种关系。不幸的是，从测量的角度来看，人际连续性并不能得到很好的描述。82003年，Saultz进一步将跨学科或基于团队的连续性描述为一种护理，当患者需要涵盖医学专业的一系列服务时，就可以利用患者的先前知识.8所有这些类型的连续性的一个基本特征是患者与医生之间的关系，其中包括有关该患者的个人和医疗信息，共享的位置以及对这种医患关系背后的背景特征的了解。以病人为中心的医疗

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