Francis Maureen D, Wieland Mark L, Drake Sean, Gwisdalla Keri Lyn, Julian Katherine A, Nabors Christopher, Pereira Anne, Rosenblum Michael, Smith Amy, Sweet David, Thomas Kris, Varney Andrew, Warm Eric, Wininger David, Francis Mark L
J Grad Med Educ. 2015 Mar;7(1):36-41. doi: 10.4300/JGME-D-14-00358.1.
Many internal medicine (IM) programs have reorganized their resident continuity clinics to improve trainees' ambulatory experience. Downstream effects on continuity of care and other clinical and educational metrics are unclear.
This multi-institutional, cross-sectional study included 713 IM residents from 12 programs. Continuity was measured using the usual provider of care method (UPC) and the continuity for physician method (PHY). Three clinic models (traditional, block, and combination) were compared using analysis of covariance. Multivariable linear regression analysis was used to analyze the effect of practice metrics and clinic model on continuity.
UPC, reflecting continuity from the patient perspective, was significantly different, and was highest in the block model, midrange in combination model, and lowest in the traditional model programs. PHY, reflecting continuity from the perspective of the resident provider, was significantly lower in the block model than in combination and traditional programs. Panel size, ambulatory workload, utilization, number of clinics attended in the study period, and clinic model together accounted for 62% of the variation found in UPC and 26% of the variation found in PHY.
Clinic model appeared to have a significant effect on continuity measured from both the patient and resident perspectives. Continuity requires balance between provider availability and demand for services. Optimizing this balance to maximize resident education, and the health of the population served, will require consideration of relevant local factors and priorities in addition to the clinic model.
许多内科住院医师培训项目已经对其住院医师连续性诊所进行了重组，以改善学员的门诊体验。对医疗连续性以及其他临床和教育指标的下游影响尚不清楚。
这项多机构横断面研究纳入了来自12个项目的713名内科住院医师。连续性使用常规医疗服务提供者方法（UPC）和医师连续性方法（PHY）进行测量。使用协方差分析比较了三种诊所模式（传统模式、集中模式和组合模式）。多变量线性回归分析用于分析实践指标和诊所模式对连续性的影响。
从患者角度反映连续性的UPC有显著差异，在集中模式中最高，在组合模式中处于中等水平，在传统模式项目中最低。从住院医师提供者角度反映连续性的PHY在集中模式中显著低于组合模式和传统模式项目。小组规模、门诊工作量、利用率、研究期间就诊的诊所数量以及诊所模式共同解释了UPC中62%的变异和PHY中26%的变异。
诊所模式似乎对从患者和住院医师角度衡量的连续性有显著影响。连续性需要在提供者可及性和服务需求之间取得平衡。要优化这种平衡以最大限度地提高住院医师教育水平以及所服务人群的健康状况，除了诊所模式外，还需要考虑相关的当地因素和优先事项。
