McBurney Patricia G, Moran Colleen M, Ector Walton L, Quattlebaum Thomas G, Darden Paul M
Department of Pediatrics, Medical University of South Carolina, 135 Rutledge Ave, PO Box 250561, Charleston, SC 29425, USA.
Pediatrics. 2004 Oct;114(4):1023-7. doi: 10.1542/peds.2003-0280-L.
In 1996, the Residency Review Committee-Pediatrics recommended doubling time in continuity clinic to 2 half days per week. It has yet to be demonstrated that increased time in clinic yields greater continuity of care. The objective of this study was to determine whether increasing the number of half days spent in clinic improves continuity of care for residents.
We reviewed computerized encounter records for all Medical University of South Carolina pediatric residents from 1982 to 1998. Depending on the year and the resident's training level, house staff spent varying amounts of time in continuity clinic. Time in clinic was estimated from grants and materials generated in the residency program. We calculated continuity of care from the resident's perspective for each individual resident per year using the Continuity for Physician (PHY) formula.
Continuity for 488 resident-years (200 residents) was evaluated. Residents spent from 10% to 30% of their time per year in clinic. Mean PHY was 57% (interns), 62% (second-year residents), and 52% (third-year residents). The correlation coefficient (R) between PHY and percentage of time in clinic was .22. In multivariable modeling, percentage of time in clinic, training level, and year predicted continuity. An increase of 1 half day in clinic was associated with an 11% increase in physician continuity. When analyses were limited to sick visits, R improved to .58. The effect size remained 11%. However, training level and academic year were no longer significant.
Increasing time spent in clinic improves continuity and may indeed enhance the quality of this fundamental experience.
1996年，儿科住院医师评审委员会建议将连续性门诊时间增加一倍，至每周两个半天。但门诊时间增加是否能带来更高的医疗连续性，这一点尚未得到证实。本研究的目的是确定增加在门诊的半天时间数量是否能提高住院医师的医疗连续性。
我们查阅了南卡罗来纳医科大学1982年至1998年所有儿科住院医师的计算机化诊疗记录。根据年份和住院医师的培训水平，住院医师在连续性门诊花费的时间各不相同。门诊时间是根据住院医师培训项目产生的拨款和资料估算的。我们使用医生连续性（PHY）公式，从每位住院医师每年的角度计算医疗连续性。
对488个住院医师年度（200名住院医师）的连续性进行了评估。住院医师每年在门诊花费的时间从10%到30%不等。平均PHY值分别为实习医师57%、二年级住院医师62%、三年级住院医师52%。PHY与门诊时间百分比之间的相关系数（R）为0.22。在多变量建模中，门诊时间百分比、培训水平和年份可预测连续性。门诊增加一个半天与医生连续性提高11%相关。当分析仅限于诊治患病患者时，R值提高到0.58。效应大小仍为11%。然而，培训水平和学年不再具有显著性。
增加在门诊的时间可提高连续性，并且确实可能提升这一基础经历的质量。
