Change in Residents' Experience in Continuity Clinic After Patient-Focused Primary Care Redesign

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• 作者：Benjamin N. Fogel ; MD ; MPH^a ; ^{bfogel@hmc.psu.edu" class="auth_mail" title="E-mail the corresponding author} ; Stephen Warrick ; MD^b ; Jonathan A. Finkelstein ; MD ; MPH^c ; Melissa Klein ; MD ; MEd^b
• 关键词：continuity clinic ; primary care ; quality improvement ; redesign ; resident education
• 刊名：Academic Pediatrics
• 出版年：2016
• 出版时间：September-October 2016
• 年：2016
• 卷：16
• 期：7
• 页码：616-620
• 全文大小：197 K

文摘

Evaluation of efforts to redesign primary care has primarily focused on clinical services, with limited assessment of the effect on learners. This study evaluated the change in pediatric residents' perception of training, teamwork, and patient care in 2 different continuity clinic settings that were implementing patient-focused primary care redesign.

Methods

Continuity clinic residents at 2 large urban pediatric training programs completed a survey, developed de novo, before and after primary care redesign. Differences in the proportion of positive (≥4 of 5) ratings before and after redesign were compared using chi-squared tests in 2 practice sites, each of which focused on improving specific aspects of their practice.

Results

The response rate was >70% in both sites and in both years. Residents in the site focused on teamwork and continuity were more likely to report improved teamwork training (64% vs 83%; P < .05) and teamwork among residents (82% vs 98%; P < .05) after redesign. Perception of overall quality of care in clinic also improved (47% vs 68%; P < .05). Residents in the site focused on clinic flow were more likely to report that physicians, nurses, and administrative staff worked together to optimize patient flow after redesign (25% vs 48%; P < .05). No improvements were seen in domains without focused interventions in either site.

Conclusions

Practice redesign focused on clinical outcomes can positively affect resident perception of their training and clinical experience in continuity clinic. Future redesign efforts deliberately involving residents might further enhance continuity clinic training.