P. Adam is vice chair for clinical affairs and associate professor, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota.
D. Hersch is research facilitator, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota.
Acad Med. 2022 Feb 1;97(2):233-238. doi: 10.1097/ACM.0000000000004180.
Family medicine faculty and residents have observed that continuity clinic is often unsatisfying, attributed to a lack of patient and team continuity and erratic clinic schedules pieced together after the prioritization of hospital service and rotation schedules.
In 2019, a 3-year Clinic First project, called Clinic as Curriculum (CaC), was launched across the 4 family medicine residencies of the Department of Family Medicine and Community Health, University of Minnesota Medical School. The department began publishing quarterly CaC dashboard data. Each clinic completed a baseline assessment of their performance on the 13 Building Blocks of High-Performing Primary Care. Using their baseline data, each clinic identified which block or blocks, in addition to the blocks on continuity of care and resident scheduling, to focus on. The plan is to collaboratively implement the overall and local goals using dashboard data and iterative process improvement over 3 years.
At baseline, clinics functioned quite well with respect to the 13 building blocks, but CaC dashboard data varied across the 4 clinics, with large variation between clinics on how frequently faculty were scheduled in the clinic and the proportion of total clinic visits seen by faculty. Resident continuity rates were low (range, 38%-47%). Level loading (consistent physician availability to meet patient demand) rates ranged from 1 to 11 days a month. Regarding resident schedules, 2 programs are moving from 4-week to 2-week inpatient blocks, and 2 programs are exploring longitudinal scheduling. One clinic will assign faculty and residents to specific clinic days. Two clinics are implementing microteams of 1 faculty and 3-4 residents.
The authors plan to analyze the dashboard data longitudinally; explore microteams, team continuity, and team scheduling adherence; and develop and implement resident scheduling changes over the next 3 years.
家庭医学教师和住院医师观察到，连续性诊所常常不尽如人意，这归因于患者和团队连续性的缺乏，以及在优先考虑医院服务和轮转计划后拼凑而成的不稳定的诊所日程安排。
2019 年，在明尼苏达大学医学院家庭医学和社区健康系的 4 个家庭医学住院医师培训项目中启动了为期 3 年的 Clinic First 项目，名为 Clinic as Curriculum（CaC）。该系开始发布季度 CaC 仪表板数据。每个诊所都对其在高绩效初级保健的 13 个构建模块上的表现进行了基线评估。每个诊所使用其基线数据确定除了连续性护理和住院医师排班之外，还需要关注哪些模块或模块。计划是在 3 年内使用仪表板数据和迭代过程改进来共同实现整体和局部目标。
在基线时，诊所在 13 个构建模块方面运作良好，但 CaC 仪表板数据在 4 个诊所之间存在差异，诊所之间的差异很大，包括教职员工在诊所的排班频率以及教职员工在总诊所就诊中的比例。住院医师连续性率较低（范围为 38%-47%）。水平加载（满足患者需求的一致医生可用性）率从每月 1 天到 11 天不等。关于住院医师的日程安排，有 2 个项目正在从 4 周住院转变为 2 周住院，有 2 个项目正在探索纵向排班。一个诊所将为教职员工和住院医师分配特定的诊所日。有两个诊所正在实施由 1 名教职员工和 3-4 名住院医师组成的微型团队。
作者计划对仪表板数据进行纵向分析；探索微型团队、团队连续性和团队排班的遵守情况；并在未来 3 年内制定和实施住院医师排班变更。
