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Improving Patient-Provider Continuity in a Large Urban Academic Primary Care Network

Published:November 12, 2021DOI:https://doi.org/10.1016/j.acap.2021.11.005

      Abstract

      Objective

      Although patient-provider continuity improves care delivery and satisfaction, poor continuity with primary care providers (PCP) often exists in academic centers. We aimed to increase patient empanelment from 0% to 90% and then increase the percent of well-child care (WCC) visits scheduled with the PCP from 25.6% to 50%, without decreasing timely access that might result if patients waited for PCP availability.

      Methods

      Nationwide Children's Hospital Primary Care Network cares for >120,000 mostly Medicaid-enrolled patients across 13 offices. Before 2017, patients were empaneled to an office, not individual PCPs. We empaneled patients to PCPs, reduced provider floating, implemented continuity-promoting scheduling guidelines, scheduled future WCC visits for patients ≤15 months during check-in for their current one, and encouraged online scheduling. We tracked the percentage of all WCC visits that were scheduled with the patient's PCP and the percentage of subsequent WCC visits for patients ≤15 months that were scheduled during the current visit, and provided feedback to schedulers. We followed emergency department (ED) utilization and visit show rates. WCC visit completion rates were tracked using HEDIS metrics.

      Results

      Patient empanelment increased from 0% to >90% (P < .001). Patient-provider WCC continuity increased from 25.6% to 54.7% (P < .001). A 20.5% decrease in ED utilization rate was associated with continuity project initiation. Empaneled patients demonstrated higher show rates (76.9%) versus unempaneled patients (71.4%; P < .001). WCC completion rates increased from 52.6% to 60.7%.

      Conclusions

      WCC continuity more than doubled after interventions and was associated with decreased ED utilization, higher show rates, and increased timely WCC completion.

      Keywords

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      References

        • Medical Home Initiatives for Children With Special Needs Project Advisory Committee; American Academy of Pediatrics
        The medical home.
        Pediatrics. 2002; 110: 184-186
        • Gill JM
        • Mainous 3rd, AG
        • Nsereko M.
        The effect of continuity of care on emergency department use.
        Arch Fam Med. 2000; 9: 333-338
        • Gill JM
        • Mainous 3rd, AG
        The role of provider continuity in preventing hospitalizations.
        Arch Fam Med. 1998; 7: 352-357
        • Yang KT
        • Yin CH
        • Hung YM
        • et al.
        Continuity of care is associated with medical costs and inpatient days in children with cerebral palsy.
        Int J Environ Res Public Health. 2020; 17: 2913
        • Mainous 3rd, AG
        • Gill JM.
        The importance of continuity of care in the likelihood of future hospitalization: is site of care equivalent to a primary clinician?.
        Am J Public Health. 1998; 88: 1539-1541
        • Brousseau DC
        • Meurer JR
        • Isenberg ML
        • et al.
        Association between infant continuity of care and pediatric emergency department utilization.
        Pediatrics. 2004; 113: 738-741
        • Christakis DA
        • Mell L
        • Koepsell TD
        • et al.
        Association of lower continuity of care with greater risk of emergency department use and hospitalization in children.
        Pediatrics. 2001; 107: 524-529
        • May M
        • Brousseau DC
        • Nelson DA
        • et al.
        Why parents seek care for acute illness in the clinic or the ED: the role of health literacy.
        Acad Pediatr. 2018; 18: 289-296
        • Shin DW
        • Cho J
        • Yang HK
        • et al.
        Impact of continuity of care on mortality and health care costs: a nationwide cohort study in Korea.
        Ann Fam Med. 2014; 12: 534-541
        • Cabana MD
        • Jee SH.
        Does continuity of care improve patient outcomes?.
        J Fam Pract. 2004; 53: 974-980
        • Saultz JW
        • Lochner J.
        Interpersonal continuity of care and care outcomes: a critical review.
        Ann Fam Med. 2005; 3: 159-166
        • Baker R
        • Mainous 3rd, AG
        • Gray DP
        • et al.
        Exploration of the relationship between continuity, trust in regular doctors and patient satisfaction with consultations with family doctors.
        Scand J Prim Health Care. 2003; 21: 27-32
        • Love MM
        • Mainous 3rd, AG
        • Talbert JC
        • et al.
        Continuity of care and the physician-patient relationship: the importance of continuity for adult patients with asthma.
        J Fam Pract. 2000; 49: 998-1004
        • Enlow E
        • Passarella M
        • Lorch SA.
        Continuity of care in infancy and early childhood health outcomes.
        Pediatrics. 2017; 140: e20070339https://doi.org/10.1542/peds.2017-0339
        • Berwick DM
        • Nolan TW
        • Whittington J.
        The triple aim: care, health, and cost.
        Health Aff (Millwood). 2008; 27: 759-769
        • Belardi FG
        • Weir S
        • Craig FW.
        A controlled trial of an advanced access appointment system in a residency family medicine center.
        Fam Med. 2004; 36: 341-345
        • Chaudhry SR
        • Hamma-Attisha M
        • LaChance J
        • et al.
        Primary resident physician: improving continuity of care.
        J Grad Med Educ. 2015; 7: 247-252
        • Breslau N
        • Reeb K.
        Continuity of care in a university based practice.
        J Med Educ. 1975; 50: 965-969
        • Darden PM
        • Ector W
        • Moran C
        • et al.
        Comparison of continuity in a resident versus private practice.
        Pediatrics. 2001; 108: 1263-1268
        • Bice T
        • Boxerman S.
        A quantitative measure of continuity of care.
        Med Care. 1977; 15: 347-349
        • Mohammed MA
        • Laney D.
        Overdispersion in health care performance data: Laney's approach.
        Qual Saf Health Care. 2006; 15: 383-384
      1. The National Committee for Quality Assurance. Child and adolescent well-care visits. Available at: https://www.ncqa.org/hedis/measures/child-and-adolescent-well-care-visits/, Accessed October 12, 2020