Improving continuity by increasing clinic frequency in a residency setting.

BACKGROUND AND OBJECTIVES: Continuity of care is required in family practice training programs. However, continuity for some patients may not be adequately served in the traditional training model that has residents in the family practice center (FPC) for 1 to 3 half-day clinics per week. This study sought to determine if increasing clinic frequency in a family practice residency has an effect on continuity of care.

METHODS: On January 1, 1999, the residency program changedfrom a traditional clinic scheduling model to one where all residents saw patients in the FPC 4 to 5 days a week. By using shorter clinic sessions, total resident time in the FPC was nearly unchanged (decreasing 5% overall). We reviewed 1,709 randomly selected billing records for residents' patients who frequently utilized medical care (three or more visits within 6 months) and assessed continuity for 1 year before and after this intervention, using both the modified, modified continuity index (MMCI) and the percentage of visits to the primary care provider (PCP).

RESULTS: Overall, the MMCIfor patients who frequently saw residents increasedfrom .59 to .64. The average frequency with which these patients saw their PCPs improvedfor the first-year class (from 51% of visits before implementation to 72% after) and the third-year class (from 66% of visits to 72%).

CONCLUSIONS: Scheduling daily resident clinics in the FPC increased continuity among patients who frequently saw residents beyond that achieved using traditional scheduling, without increasing total resident time in the FPC.