47. PREDICTING AND UNDERSTANDING CONTINUITY IN A RESIDENT CONTINUITY CLINIC

Abstract

Background The longitudinal experience in continuity clinic plays a crucial role in building a strong foundation in general pediatrics. Pediatric residents struggle to maintain continuity in their clinics, which may impact comfort in managing common chronic pediatric conditions. Little is known about the prevalence of common chronic diseases managed on resident panels and if they are associated with resident continuity. Objectives We hypothesize that the presence of common chronic disease will be associated with resident continuity. We will also determine prevalence of common chronic diseases seen in clinic. This study will help inform a prospective quality improvement (QI) project. Methods Unique patients that had been seen for at least two non-urgent care visits (with at least one well visit) in our residency continuity clinic over a 2-year period were identified. To date, 618 of 685 patient charts reviewed meet the visit criteria. We have defined continuity as seeing the same resident provider for two or more visits. We have defined a resident primary care provider (PCP) as a resident who has seen a patient for >50% of their visits. Patient visit data and presence of chronic diseases for each patient were recorded in a password-protected Excel database. Results Of the 685 patients reviewed, there were 5584 unique visits, of which 3775 visits were related to well care (68%). Of those that met inclusion criteria (618), 309 (50%) met our definition for continuity, and 116 (16.9%) met our definition for having an identified resident PCP. For patients that had an identified resident PCP, they were less likely than those without one to have chronic diseases such as ADHD (0.86% vs. 3.56%, OR 0.28), obesity (6% vs. 15.5%, OR 0.78) and anxiety/depression (1.7% vs. 5.5%, OR 0.53). Conclusions While data collection/analysis is incomplete, it is clear that achieving continuity in a resident clinic is challenging. Chronic diseases are unlikely to be associated with resident continuity. QI interventions may be needed to increase resident continuity particularly among patients with common chronic pediatric conditions