204 - Measuring Continuity in Resident Clinics: It can be done!

Publication Number: 204.5802

Catherine D. Shubkin, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States; Susanne Tanski, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States; Cheryl Anderson, Dartmouth Health, Lebanon, NH, United States

Background: Outpatient longitudinal care in a medical home is a core requirement of pediatric residency accreditation. Residents develop a core panel of patients with whom they have “continuity of care”. Continuity benefits include the quadruple aim of enhanced patient experience, improved population health, reduced costs, and improved care team well-being. Little agreement exists on standardized continuity measures. Although pediatric programs are not required to measure continuity, programs should have this capacity. Here, we describe process development of two continuity measures within an academic medical center primary care clinic.

Objective: In conjunction with practice management and medical informatics, to develop metrics defining continuity in two measures: patient sees primary care provider (PCP,) or “patient-sided continuity” and PCP sees own patient, or “resident-sided continuity”.

Design/Methods: Over 4 years, custom monthly reports were generated with practice management, billing services, and medical informatics partners. Two separate measures were constructed as quality indicators of continuity. Patient-sided continuity is assessed at the individual provider level by determining the number of “panel” patients seen by the resident PCP in the month, divided by the total number of panel patients seen by anyone in the practice that month. PCP continuity is assessed similarly by the number of “panel” patients seen by the resident PCP in the month, divided by the total number of all patients seen by the resident PCP that month. These metrics are aggregated based on reporting data available within our electronic medical record, EPIC.

Results: We identified key components to measure continuity in a primary care clinic that required interdisciplinary coordination with practice management, billing services, residency leadership and medical informatics. First, resident physicians must be identified in the medical record as the PCP. Second, medical informatics teams must partner to develop coding to generate continuity reports. Third, schedule access and optimization requires residency leadership to support at least 6 months advance scheduling with a minimum of changes. Finally, data should be routinely reviewed to seek optimization (Figure 1).

Conclusion(s): Continuity of patient care is an important metric needed for residency leadership to ensure adequate exposure in a primary care medical home. Barriers to develop these metrics can be overcome with the collaboration of a multidisciplinary team including residency leadership, practice management, billing services, and medical informatics.

Figure 1
3 year trends of resident continuity experience: patient level & resident level