Published online October 1, 2004
PEDIATRICS Vol. 114 No. 4 October 2004, pp. 1023-1027 (doi:10.1542/peds.2003-0280-L)
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Time in Continuity Clinic as a Predictor of Continuity of Care for Pediatric Residents

Patricia G. McBurney, MD*, Colleen M. Moran, MD*, Walton L. Ector, MD*, Thomas G. Quattlebaum, MD{ddagger} and Paul M. Darden, MD*

* Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
{ddagger} Charleston Pediatrics, Charleston, South Carolina

Objective. In 1996, the Residency Review Committee–Pediatrics recommended doubling time in continuity clinic to 2 half days per week. It has yet to be demonstrated that increased time in clinic yields greater continuity of care. The objective of this study was to determine whether increasing the number of half days spent in clinic improves continuity of care for residents.

Methods. We reviewed computerized encounter records for all Medical University of South Carolina pediatric residents from 1982 to 1998. Depending on the year and the resident’s training level, house staff spent varying amounts of time in continuity clinic. Time in clinic was estimated from grants and materials generated in the residency program. We calculated continuity of care from the resident’s perspective for each individual resident per year using the Continuity for Physician (PHY) formula.

Results. Continuity for 488 resident-years (200 residents) was evaluated. Residents spent from 10% to 30% of their time per year in clinic. Mean PHY was 57% (interns), 62% (second-year residents), and 52% (third-year residents). The correlation coefficient (R) between PHY and percentage of time in clinic was .22. In multivariable modeling, percentage of time in clinic, training level, and year predicted continuity. An increase of 1 half day in clinic was associated with an 11% increase in physician continuity. When analyses were limited to sick visits, R improved to .58. The effect size remained 11%. However, training level and academic year were no longer significant.

Conclusion. Increasing time spent in clinic improves continuity and may indeed enhance the quality of this fundamental experience.

Key Words: continuity clinic • residency • Residency Review Committee for Pediatrics

Abbreviations: ACGME, Accreditation Council for Graduate Medical Education • COC, Continuity of Care • PHY, Continuity for Physician • MUSC, Medical University of South Carolina • WCC, well-child care

Accepted Dec 4, 2003.




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