• J Gen Intern Med · Nov 2012

    Outcomes for resident-identified high-risk patients and resident perspectives of year-end continuity clinic handoffs.

    • Amber T Pincavage, Shana Ratner, Megan L Prochaska, Meryl Prochaska, Julie Oyler, Andrew M Davis, and Vineet M Arora.
    • Department of Medicine, University of Chicago, Chicago, IL 60637, USA. apincava@medicine.bsd.uchicago.edu
    • J Gen Intern Med. 2012 Nov 1;27(11):1438-44.

    BackgroundMany patients nationwide change their primary care physician (PCP) when internal medicine (IM) residents graduate. Few studies have examined this handoff.ObjectiveTo assess patient outcomes and resident perspectives after the year-end continuity clinic handoffDesignRetrospective cohortParticipantsPatients who underwent a year-end clinic handoff in July 2010 and a comparison group of all other resident clinic patients from 2009-2011. PGY2 IM residents surveyed from 2010-2011.MeasurementsPercent of high-risk patients after the clinic handoff scheduled for an appointment, who saw their assigned PCP, lost to follow-up, or had an acute visit (ED or hospitalization). Perceptions of PGY2 IM residents surveyed after receiving a clinic handoff.ResultsThirty graduating residents identified 258 high-risk patients. While nearly all patients (97 %) were scheduled, 29 % missed or cancelled their first new PCP visit. Only 44 % of patients saw the correct PCP and six months later, one-fifth were lost to follow-up. Patients not seen by a new PCP after the handoff were less likely to have appropriate follow-up for pending tests (0 % vs. 63 %, P<0.001). A higher mean no show rate (NSR) was observed among patients who missed their first new PCP visit (22 % vs. 16 % NSR, p<0.001) and those lost to follow-up (21 % vs. 17 % NSR, p=0.019). While 47 % of residents worried about missing important data during the handoff, 47 % reported that they do not perceive patients as "theirs" until they are seen by them in clinic.ConclusionsWhile most patients were scheduled for appointments after a clinic handoff, many did not see the correct resident and one-fifth were lost to follow-up. Patients who miss appointments are especially at risk of poor clinic handoff outcomes. Future efforts should improve patient attendance to their first new PCP visit and increase PCP ownership.

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