Abstract

1. To assess the impact of a resident-based continuity clinic on no-show rates for follow-up care at a public safety net hospital. 2. To evaluate the effect of a continuity clinic on resident education. Our hospital is a major tertiary referral medical center and public safety net hospital for a large urban population. The department of Radiation Oncology scheduled 1,898 follow-up visits for the 2016 calendar year. Previously, we managed the department with four services that handled both new patient evaluations and follow-up visits based on disease site. Beginning in July 2016, the department was restructured to incorporate a resident-based continuity clinic model. New patient consultations continued to be evaluated and treated by the four disease site based services, while patients who finished treatment were assigned to the follow-up clinic of the resident who completed the simulation and treatment planning. All pre-existing patients in follow-up were randomly distributed amongst the clinics. All follow-up visits were staffed with a disease site-specific attending physician who supervised all care. Between 1 January 2016 and 30 June 2016, a total of 907 follow-up visits were scheduled according to the team based system. 232 of the scheduled appointments resulted in a no-show visit, which is a rate of 26%. Between 1 July 2016 and 30 December 2016, a total of 991 visits were scheduled according to the resident-based continuity clinic model. 163 of the scheduled appointments resulted in a no-show visit, which is a rate of 16%. Logistic regression was performed on the data set and showed a significantly improved no-show rate with p<0.0001. At any given time, there are residents who have an off-site rotation. The patients in their follow-up clinics are covered by a mid-level practitioner under the supervision of a disease site-specific attending physician. The likelihood of having a no-show visit appears to be correlated with absence of the primary provider (the resident) even in the continuity clinic model. Residents reported a significantly higher satisfaction with the new clinic model, an improved sense of connectedness to their patients, and overall higher satisfaction with education in follow-up care. As residents can follow the same patients for the duration of the residency program, they are able to assess for the short and long term adverse effects of their own treatment plans. They also reported feeling less likely to miss details of care due to “hand-off” issues when caring for their own patients. In the unique environment of a large urban public safety net hospital, care is often based upon a disease site model which allows for managing complicated situations quickly, but can result in less personal connection and may negatively impact patient care. We demonstrated that adopting a resident-based continuity clinic model improves patient compliance with follow-up care and the learning experience for resident physicians.

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