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Patient Follow-up in an Urban Resident Continuity Clinic: An Initiative to Improve Scheduling Practices.

ABSTRACT: INTRODUCTION: Failure to schedule timely follow-up appointments may impair continuity and quality of care, especially for patients with low health literacy and unstable living situations. Resident continuity clinics face particular challenges in scheduling patient follow-up because of residents' complex schedules and limited time in clinic. METHODS: As part of a structured quality-improvement curriculum, residents initiated discussions with clinical supervisors and clerical staff to evaluate and improve scheduling practices in an urban continuity clinic. The problem-solving process emphasized feasibility (rapid implementation/evaluation cycle, low time/resource burden) and measurable outcomes. These discussions led to design of a new scheduling form. We evaluated the short-term impact of awareness raising by comparing scheduling rates before (month 1) versus after (months 2-3) implementation, and of the form itself by randomly selecting 2 afternoon clinics to implement the new form, with a third serving as control. RESULTS: We analyzed all patient encounters over a 3-month period (n = 910), excluding patients with a recommended follow-up interval of greater than 4 months. The proportion of appointments "never scheduled" (at 1 month after provider-requested follow-up date) declined from 18.8% (95% confidence interval [CI], 14.5%-23.9%) in month 1 to 11.4% (CI, 8.1%-15.5%) in month 3. This proportion was significantly higher before than after implementation of the form (multivariable relative risk, 1.49; 95% CI, 1.08-2.03; P = .02), both in clinics that used and did not use the form (P = .93 for difference). CONCLUSIONS: We describe a model resident-led, team-based intervention that addressed core competencies in graduate medical education while improving outpatient scheduling practices.

SUBMITTER: Dowdy DW

PROVIDER: S-EPMC3184901 | biostudies-other | 2011 Jun

REPOSITORIES: biostudies-other

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Project description:BACKGROUND: Although Internal Medicine year-end resident clinic handoffs affect numerous patients, little research has described patients' perspectives of the experience. OBJECTIVE: To 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. DESIGN: Qualitative study design using semi-structured interviews. PARTICIPANTS: High-risk patients who underwent a year-end clinic handoff in July 2011. MEASUREMENTS: Three 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. RESULTS: In 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. CONCLUSIONS: Patients face unique challenges during year-end clinic handoffs and provide insights into areas of improvement for a patient-centered handoff.

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Patient Follow-up in an Urban Resident Continuity Clinic: An Initiative to Improve Scheduling Practices.

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