Increasing Continuity While Promoting Patient Access in Academic Pediatric Primary Care

Continuity of care is important to high-quality care in pediatrics. We sought to improve continuity rates for young patients (12-24 months) in an academic pediatric primary care training site over 2 years, from 0.32 to 0.40, while maintaining exceptional patient access and prioritizing patient preference.

We conducted a quality improvement (QI) project at a practice serving ∼15,600 patients (81% Black, 4.5% Hispanic; 85.3% Medicaid enrolled). Our team identified key drivers and iteratively tested interventions, including parent interviews to understand family preferences, extending acceptable windows for scheduling when appointment was due, soliciting family preferences for continuity or access when scheduling, opening provider templates further in advance, and scheduling future appointments before discharge.

We improved the usual provider for continuity for well visits in patients aged 12 to 24 months from 0.32 to 0.42 as our primary outcome measure. Our secondary outcome measure decreased from 71% to 54% of children who never experienced continuity. Our process measures also showed improvement: we increased providers entering disposition notes when a patient is due for the next visit from 62% to 88% of encounters and from 31% to 61% of patients leaving with a scheduled future appointment. Our balancing measures of the third-next available well-child check visit and no-show rate remained stable.

Application of QI methods increased well-check continuity for young patients in an academic primary care practice while maintaining exceptional patient access and prioritizing patient preference.