LaVine Nancy A, Coletti Daniel J, Verbsky Jennifer, Block Lauren
J Grad Med Educ. 2020 Apr;12(2):208-211. doi: 10.4300/JGME-D-19-00605.1.
Clinical continuity is recognized as a driver of satisfaction for patients and physicians. Greater continuity may positively affect trainee decisions to enter primary care. Maintaining clinical continuity remains a challenge in residency clinics.
We determined whether enhanced scheduling support was associated with improvement in internal medicine resident continuity with patients.
This study was conducted from June 2017 to December 2018. In the intervention clinic, a single scheduling staff member (ratio of 10 residents to 1 scheduler) was colocated within the clinical space, allowing the scheduler to participate in clinical discussions and direct communication with physicians regarding future appointments. In the comparison clinic, scheduling staff (19:1 ratio) were located at a remote front desk area and relied on patient reports or electronic health record orders to identify appointment needs and arrange follow-up appointments. The main outcome of the intervention was resident continuity, calculated using the continuity for physician formula.
During the study period, mean resident continuity was 23% (range 13%-37%) in the comparison clinic (57 residents) and 54% (range 38%-66%) in the intervention clinic (10 residents). Resident continuity was significantly higher in the intervention clinic compared with the traditional control clinic for every quarter measured ( < .001 for all comparisons).
Enhancing scheduling support through colocation and a lower resident to scheduler ratios was associated with significantly higher rates of resident continuity compared with a traditional front desk model, with results sustained over 18 months.
临床连续性被认为是患者和医生满意度的驱动因素。更高的连续性可能会对实习医生进入初级医疗领域的决定产生积极影响。在住院医师诊所中，维持临床连续性仍然是一项挑战。
我们确定增强的排班支持是否与内科住院医师与患者之间连续性的改善相关。
本研究于2017年6月至2018年12月进行。在干预诊所，一名排班工作人员（住院医师与排班员比例为10:1）与临床人员同处一个空间，使排班员能够参与临床讨论，并就未来预约与医生进行直接沟通。在对照诊所，排班工作人员（比例为19:1）位于远程前台区域，依靠患者报告或电子健康记录医嘱来确定预约需求并安排随访预约。干预的主要结果是住院医师连续性，使用医生连续性公式计算。
在研究期间，对照诊所（57名住院医师）的住院医师平均连续性为23%（范围13%-37%），干预诊所（10名住院医师）为54%（范围38%-66%）。在每个测量季度中，干预诊所的住院医师连续性均显著高于传统对照诊所（所有比较P<0.001）。
与传统前台模式相比，通过同处一个空间和降低住院医师与排班员比例来增强排班支持，与住院医师连续性显著提高相关，且结果在18个月内持续存在。
