Department of Medicine, University of Chicago, Chicago, IL 60637, USA.
J Gen Intern Med. 2012 Nov;27(11):1438-44. doi: 10.1007/s11606-012-2100-y. Epub 2012 May 30.
Many patients nationwide change their primary care physician (PCP) when internal medicine (IM) residents graduate. Few studies have examined this handoff.
To assess patient outcomes and resident perspectives after the year-end continuity clinic handoff
Retrospective cohort
Patients who underwent a year-end clinic handoff in July 2010 and a comparison group of all other resident clinic patients from 2009-2011. PGY2 IM residents surveyed from 2010-2011.
Percent of high-risk patients after the clinic handoff scheduled for an appointment, who saw their assigned PCP, lost to follow-up, or had an acute visit (ED or hospitalization). Perceptions of PGY2 IM residents surveyed after receiving a clinic handoff.
Thirty graduating residents identified 258 high-risk patients. While nearly all patients (97 %) were scheduled, 29 % missed or cancelled their first new PCP visit. Only 44 % of patients saw the correct PCP and six months later, one-fifth were lost to follow-up. Patients not seen by a new PCP after the handoff were less likely to have appropriate follow-up for pending tests (0 % vs. 63 %, P<0.001). A higher mean no show rate (NSR) was observed among patients who missed their first new PCP visit (22 % vs. 16 % NSR, p<0.001) and those lost to follow-up (21 % vs. 17 % NSR, p=0.019). While 47 % of residents worried about missing important data during the handoff, 47 % reported that they do not perceive patients as "theirs" until they are seen by them in clinic.
While most patients were scheduled for appointments after a clinic handoff, many did not see the correct resident and one-fifth were lost to follow-up. Patients who miss appointments are especially at risk of poor clinic handoff outcomes. Future efforts should improve patient attendance to their first new PCP visit and increase PCP ownership.
全国许多患者在内科住院医师毕业后会更换初级保健医生。很少有研究调查这种交接。
评估年终连续性诊所交接后患者的结局和住院医师的看法。
回顾性队列研究。
2010 年 7 月接受年终诊所交接的患者和 2009-2011 年所有其他住院医师诊所患者的对照组。2010-2011 年调查的 PGY2 内科住院医师。
在诊所交接后，预约高风险患者中，有多少患者见到了指定的初级保健医生、失访或接受了急性就诊（急诊或住院）。接受诊所交接后 PGY2 内科住院医师的看法。
30 名即将毕业的住院医师确定了 258 名高风险患者。虽然几乎所有患者（97%）都被安排了，但有 29%的患者错过了或取消了他们的第一次新初级保健医生就诊。只有 44%的患者见到了正确的初级保健医生，六 个月后，五分之一的患者失访。交接后未由新初级保健医生接诊的患者进行待处理检查的后续治疗的可能性较低（0%比 63%，P<0.001）。首次新就诊时未见到初级保健医生的患者的未到诊率（NSR）较高（22%比 16%的 NSR，p<0.001），失访患者的 NSR 也较高（21%比 17%的 NSR，p=0.019）。虽然 47%的住院医师担心在交接过程中会遗漏重要数据，但 47%的住院医师报告说，直到他们在诊所见到患者，他们才认为患者是他们的。
虽然大多数患者在诊所交接后都预约了就诊，但许多患者并未见到正确的住院医师，五分之一的患者失访。错过预约的患者尤其存在较差的诊所交接结局的风险。未来的努力应改善患者首次新就诊的就诊率，并增加初级保健医生的参与度。
