Improving Continuity of Care in a Family Medicine Residency FQHC Clinic

05-02-2018 17:46

Purpose:Family medicine residents value patient continuity but tend to have difficulty attaining this experience consistently in a residency clinic. A Family Medicine Residency Federally Qualified Health Center (FQHC) continuity clinic used quality improvement (QI) techniques in a multidisciplinary team to improve patient continuity by changing the after visit summary instructions and validating the Primary Care Provider (PCP) designated in the Electronic Medical Record (EMR).

Methods:Our QI project used the Plan-Do-Study-Act (PDSA) Cycle model to improve continuity of care since there was general dissatisfaction at the continuity rate. Through multidisciplinary meetings, an aim was chosen to increase the match rate between PCP designated on EMR and PCP at visit from a baseline of 20% to goal of 30% with two interventions: (1) Medical Assistants (MAs) were trained to verify the patient’s PCP and to make the appropriate changes in the EMR after the resident sees the patient. (2)Team residents were trained to optimize after visit follow-up instructions in the EMR to facilitate appointment scheduling with the continuity resident by scheduling staff. Throughout this process, patients, residents, and support staff were surveyed about the new work flow to inform the ongoing QI team PDSA process. 

Results:Staff surveys showed call center staff almost always verify PCP. MAs sometimes verify PCP though they estimated this process to take about one minute. The call center was more satisfied with resident physician follow-up instructions than front desk and MAs after the intervention. Patient (N= 64, mean age 37.5 yo, 73.4% female) surveys showed significantly higher satisfaction with PCP continuity than the previous PDSA cycle (p <.05). Residents (100% response rate, 8 control, 8 intervention) who had the intervention were significantly more satisfied (p<.05) with the new process for completing the after visit summary follow-up instructions than the control group. The intervention group also had a higher PCP match rate than the control group indicating the after visit instructions may have helped improve continuity further.

Conclusions:By the end of the 4.5 month PDSA cycle, the aim was achieved with the intervention team’s PCP visit match rate increased to 35% from a baseline of 20%. Ultimately, family medicine residents desire more continuity which can be achieved through simple interventions that optimize EMR usage.

Author(s):Mai-Linh N. Tran, MD; Daniel Reichert, MD; Kelly R. Morton, PhD
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Continuity QI Poster STFM 2018 tran reichert morton FINAL.pdf   685 KB   1 version
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