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• W3210562773 abstract "Introduction: Continuity of care between patients and physicians is the backbone of a successful patient-physician relationship. Continuity reduces mortality, improves satisfaction, and encourages disclosure, leading to personalized care. The ACGME requirement for gastroenterology fellowship emphasizes its importance, suggesting one half day per week dedicated to continuity clinic. Our project aimed to analyze barriers to continuity and improve follow-up rates. Methods: Our fellows clinic is part of an academic safety-net hospital serving a low-income, uninsured, vulnerable population with challenges such as health literacy and access to care. We defined continuity as a patient previously seen by the same fellow. Need for follow up was determined by the fellow’s note or with a diagnosis of IBD or cirrhosis. Pre-intervention data collection took place Oct-Dec 2020. We used a root cause analysis to identify factors resulting in poor continuity of care, Figure 1a. We then implemented a Plan-Do-Study-Act cycle which involved fellow education and messaging a scheduler following visits Feb-Mar 2021. For our second cycle, we included follow up time on the EMR and patient instructions thereby involving patients in the responsibility to schedule follow up, Figure 1b. Outcome measures were continuity and follow up scheduled rates. Results: Of 298 visits in the pre-intervention period, 64 patients were previously seen by the same provider with a 21% continuity rate. During intervention, with 94 of 230 patients were seen by the same provider, with a 41% continuity rate. This is a statistically significant increase in continuity (Chi-square P=< .00001). Pre-intervention, 159/320 (50%) patients needing follow up had follow up scheduled. During our first test of change, 74 of 112 patients eligible for follow up (66%) were made a follow up, which was a statistically significant increase (Chi square P=< .05). During our second test of change, 44 of 82 patients eligible to make follow up (54%) were made follow up which was increased from baseline though not statistically significant. We also analyzed factors including no-show rates, fellow year, and reasons for visit, in Table 1. Conclusion: By educating our fellows, staff, and patients to be proactive about ensuring follow up and creating system changes to scheduling follow up, we increased continuity of care by 20% and follow up scheduling by 16% with our interventions. Similar systems can be implemented in other fellow clinics to offer all patients optimal care.Figure 1.: Figure 1a: Root cause analysis of poor continuity in clinic Figure 1b: Continuity rates (%) over time (weeks).Table 1.: Pre and Post Intervention Clinic Visit Characteristics." @default.
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• W3210562773 date "2021-10-01" @default.
• W3210562773 modified "2023-09-27" @default.
• W3210562773 title "S1311 Improving Continuity of Care in a Gastroenterology Fellowship Clinic" @default.
• W3210562773 doi "https://doi.org/10.14309/01.ajg.0000778776.26854.29" @default.
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