Dataset Information

Outcomes for resident-identified high-risk patients and resident perspectives of year-end continuity clinic handoffs.

ABSTRACT:

Background

Many patients nationwide change their primary care physician (PCP) when internal medicine (IM) residents graduate. Few studies have examined this handoff.

Objective

To assess patient outcomes and resident perspectives after the year-end continuity clinic handoff

Design

Retrospective cohort

Participants

Patients who underwent a year-end clinic handoff in July 2010 and a comparison group of all other resident clinic patients from 2009-2011. PGY2 IM residents surveyed from 2010-2011.

Measurements

Percent of high-risk patients after the clinic handoff scheduled for an appointment, who saw their assigned PCP, lost to follow-up, or had an acute visit (ED or hospitalization). Perceptions of PGY2 IM residents surveyed after receiving a clinic handoff.

Results

Thirty graduating residents identified 258 high-risk patients. While nearly all patients (97 %) were scheduled, 29 % missed or cancelled their first new PCP visit. Only 44 % of patients saw the correct PCP and six months later, one-fifth were lost to follow-up. Patients not seen by a new PCP after the handoff were less likely to have appropriate follow-up for pending tests (0 % vs. 63 %, P<0.001). A higher mean no show rate (NSR) was observed among patients who missed their first new PCP visit (22 % vs. 16 % NSR, p<0.001) and those lost to follow-up (21 % vs. 17 % NSR, p=0.019). While 47 % of residents worried about missing important data during the handoff, 47 % reported that they do not perceive patients as "theirs" until they are seen by them in clinic.

Conclusions

While most patients were scheduled for appointments after a clinic handoff, many did not see the correct resident and one-fifth were lost to follow-up. Patients who miss appointments are especially at risk of poor clinic handoff outcomes. Future efforts should improve patient attendance to their first new PCP visit and increase PCP ownership.

SUBMITTER: Pincavage AT

PROVIDER: S-EPMC3475812 | biostudies-literature | 2012 Nov

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Outcomes for resident-identified high-risk patients and resident perspectives of year-end continuity clinic handoffs.

Pincavage Amber T AT Ratner Shana S Prochaska Megan L ML Prochaska Meryl M Oyler Julie J Davis Andrew M AM Arora Vineet M VM

Journal of general internal medicine 20120530 11

<h4>Background</h4>Many patients nationwide change their primary care physician (PCP) when internal medicine (IM) residents graduate. Few studies have examined this handoff.<h4>Objective</h4>To assess patient outcomes and resident perspectives after the year-end continuity clinic handoff<h4>Design</h4>Retrospective cohort<h4>Participants</h4>Patients who underwent a year-end clinic handoff in July 2010 and a comparison group of all other resident clinic patients from 2009-2011. PGY2 IM residents ...[more]

PMID: 22644462

Similar Datasets

Project description:BackgroundAlthough Internal Medicine year-end resident clinic handoffs affect numerous patients, little research has described patients' perspectives of the experience.ObjectiveTo describe patients' perceptions of positive and negative experiences pertaining to the year-end clinic handoff; to rate patient satisfaction with aspects of the clinic handoff and identify whether or not patients could name their new physicians.DesignQualitative study design using semi-structured interviews.ParticipantsHigh-risk patients who underwent a year-end clinic handoff in July 2011.MeasurementsThree months post-handoff, telephone interviews were conducted with patients to elicit their perceptions of positive and negative experiences. An initial coding classification was developed and applied to transcripts. Patients were also asked to name their primary care physician (PCP) and rate their satisfaction with the handoff.ResultsIn all, 103 telephone interviews were completed. Patient experiences regarding clinic handoffs were categorized into four themes: (1) doctor-patient relationships (i.e. difficulty building rapport); (2) clinic logistics (i.e. difficulty rescheduling appointments); (3) process of the care transition (i.e. patient unaware transition occurred); and (4) patient safety-related issues (i.e. missed tests). Only 59 % of patients could correctly name their new PCP. Patients who reported that they were informed of the clinic transition by letter or by telephone call from their new PCP were more likely to correctly name them (65 % vs. 32 % p = 0.007), report that their new doctor assumed care for them immediately (81 % [68/84] vs. 53 % [10/19], p = 0.009) and report satisfaction with communication between their old and new doctors (80 % [67/84] vs. 58 % [11/19], p = 0.04). Patients reported positive experiences such as learning more about their new physician through personal sharing, which helped them build rapport. Patients who reported being aware of the medical education mission of the clinic tended to be more understanding of the handoff process.ConclusionsPatients face unique challenges during year-end clinic handoffs and provide insights into areas of improvement for a patient-centered handoff.

Project description:BackgroundContinuity clinics are a critical component of outpatient internal medicine training. Little is known about the population of patients cared for by residents and how these physicians perform.ObjectivesTo compare resident and faculty performance on standard population health measures. To identify potential associations with differences in performance, specifically medical complexity, psychosocial vulnerability, and rates of patient loss.Setting and participantsLarge academic primary care clinic caring for 40,000 patients. One hundred ten internal medicine residents provide primary care for 9,000 of these patients; the remainder are cared for by faculty.Study designDescriptive analysis using review of the medical record and hospital administrative data.Main measuresWe compared resident and faculty performance on standard population health measures, including cancer screening rates, chronic disease care, acute and chronic medical complexity, psychosocial vulnerability, and rates of patient loss. We evaluated the success of resident transition by measuring rates of kept continuity visits 18 months after graduation.Key resultsPerformance on all clinical outcomes was significantly better for faculty compared to residents. Despite similar levels of medical complexity compared to faculty patients, resident patients had significantly higher levels of psychosocial vulnerability across all measured domains, including health literacy, economic vulnerability, psychiatric illness burden, high-risk behaviors, and patient engagement. Resident patients experienced higher rates of patient loss than faculty patients (38.5 vs. 18.8%) with only 46.5% of resident patients with a kept continuity appointment in the practice 18 months after graduation.ConclusionsIn this large academic practice, resident performance on standard population health measures was significantly lower than faculty. This may be explained in part by the burden of psychosocial vulnerability of their patients and systems that do not effectively transition patients after graduation. These findings present an opportunity to improve structural equity for these vulnerable patients and developing physicians.

Dataset Information

Outcomes for resident-identified high-risk patients and resident perspectives of year-end continuity clinic handoffs.

Background

Objective

Design

Participants

Measurements

Results

Conclusions

Publications

Outcomes for resident-identified high-risk patients and resident perspectives of year-end continuity clinic handoffs.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets