Factors Associated With Resident Continuity in Ambulatory Training Practices

Area of Science:

• Primary Care Medicine
• Healthcare Quality Improvement
• Medical Education

Background:

• Continuity of care is essential for resident education in primary care.
• Understanding continuity differences between teaching and nonteaching practices is crucial.

Purpose of the Study:

• Compare continuity of care in resident vs. nonteaching practices.
• Identify factors influencing resident practice continuity.
• Examine the link between continuity and quality of care measures.

Main Methods:

• Analyzed over 117,000 visits to resident practices and 270,000 visits to nonteaching practices.
• Defined continuity from both clinician and patient perspectives.
• Used logistic regression to assess factors affecting continuity, controlling for patient and clinician variables.

Main Results:

• Continuity was significantly higher in nonteaching sites (87.3%) than resident practices (56.2%).
• Factors improving resident continuity included: no advanced practice providers, consistent scheduling protocols, rescheduling policies, increased faculty clinical time, and dismissal policies for missed appointments.
• Higher continuity correlated with better diabetic control, hypertension management, and increased screening rates for colonoscopies and mammograms.

Conclusions:

• Increased clinical faculty time, standardized scheduling protocols, and the absence of advanced practice providers are key to enhancing continuity in resident practices.
• Improved continuity of care is directly associated with better patient health outcomes and quality measures.