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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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
Article Info
Publication History
Published online: November 12, 2021
Accepted:
November 6,
2021
Received:
May 26,
2021
Footnotes
The authors have no conflicts of interest to disclose.
Identification
Copyright
Copyright © 2021 by Academic Pediatric Association
