Patient Follow-up in an Urban Resident Continuity Clinic: An Initiative to Improve Scheduling Practices.
J Grad Med Educ
; 3(2): 256-60, 2011 Jun.
Article
en En
| MEDLINE
| ID: mdl-22655154
INTRODUCTION: Failure to schedule timely follow-up appointments may impair continuity and quality of care, especially for patients with low health literacy and unstable living situations. Resident continuity clinics face particular challenges in scheduling patient follow-up because of residents' complex schedules and limited time in clinic. METHODS: As part of a structured quality-improvement curriculum, residents initiated discussions with clinical supervisors and clerical staff to evaluate and improve scheduling practices in an urban continuity clinic. The problem-solving process emphasized feasibility (rapid implementation/evaluation cycle, low time/resource burden) and measurable outcomes. These discussions led to design of a new scheduling form. We evaluated the short-term impact of awareness raising by comparing scheduling rates before (month 1) versus after (months 2-3) implementation, and of the form itself by randomly selecting 2 afternoon clinics to implement the new form, with a third serving as control. RESULTS: We analyzed all patient encounters over a 3-month period (n â=â 910), excluding patients with a recommended follow-up interval of greater than 4 months. The proportion of appointments "never scheduled" (at 1 month after provider-requested follow-up date) declined from 18.8% (95% confidence interval [CI], 14.5%-23.9%) in month 1 to 11.4% (CI, 8.1%-15.5%) in month 3. This proportion was significantly higher before than after implementation of the form (multivariable relative risk, 1.49; 95% CI, 1.08-2.03; P â=â .02), both in clinics that used and did not use the form (P â=â .93 for difference). CONCLUSIONS: We describe a model resident-led, team-based intervention that addressed core competencies in graduate medical education while improving outpatient scheduling practices.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Tipo de estudio:
Etiology_studies
/
Qualitative_research
Idioma:
En
Revista:
J Grad Med Educ
Año:
2011
Tipo del documento:
Article
Pais de publicación:
Estados Unidos