Published online July 1, 2005
PEDIATRICS Vol. 116 No. 1 July 2005, pp. 296 (doi:10.1542/peds.2005-0787)

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Continuity of Care from the Resident's Perspective

Patricia G. McBurney, MD
Paul M. Darden, MD
Department of Pediatrics,
Medical University of South Carolina,
Charleston, SC 29425

To the Editor.

We were honored to have Dr Starfield write a commentary1 on our article.2 Her work, and especially her 1992 book, has been an inspiration to this research.3 We take seriously her criticism of our measuring continuity from the resident's viewpoint. She suggests always examining continuity from the patient's vantage.1,2 Over the last 2 decades, the Accreditation Council for Graduate Medical Education has emphasized that primary care residents should have a longitudinal experience with patients or continuity.4 Therefore, the goals in a training setting are twofold: quality patient care and quality trainee experience.

Our calculation of continuity from the resident's perspective was a measure of how often the residents saw their own patients in clinic, which is an educational outcome. Any change to clinic structure including resident attendance in clinic should be evaluated for effects on both patient care and trainee experience. The focus of our article was on resident education and not on patient care.

It makes sense that if there is not quality patient care, then quality education is even more difficult to achieve and perhaps is impossible.5 Starfield's concerns prompted us to measure continuity from the patient's perspective in the same data set. We used our previously described formula for measuring patient continuity with physicians.6 We used percent of time spent in clinic for the patient's assigned provider rather than percent of time for the visit provider over the 1982–1998 period.

The correlation coefficient, r, for percent of time of assigned provider in clinic and continuity (PAT) is 0.08 (P < .01). Continuity is predicted by the assigned provider's time in clinic: in the multivariate model, for every 10% increase in time in clinic, continuity for the patient increases by 4 percentage points (P < .01). This increase in continuity persists when the visits are limited to sick visits only (4-percentage-point increase; P < .01) and when limited to well visits only (2-percentage-point increase; P = .02). The assigned provider's level of training also predicts continuity: interns have a 3-percentage-point increase in continuity from third-year residents (P < .01)

Continuity for both residents and patients improves with increased percent of time in clinic. In training settings, it is important to also study continuity for well-child care only, because these visits afford more flexibility in scheduling: this factor is increasingly important with resident duty-hour limitations. Additional work is needed to establish how much continuity is enough in both patient care and resident training.

REFERENCES

1. McBurney PG, Moran CM, Ector WL, Quattlebaum TG, Darden PM. Time in continuity clinic as a predictor of continuity of care for pediatric residents. Pediatrics.2004; 114 :1023 –1027[Abstract/Free Full Text]
2. Starfield B. On continuity of care in pediatric training [commentary]. Pediatrics.2004; 114 :1082[Free Full Text]
3. Starfield B. Primary Care: Concept, Evaluation, and Policy. New York, NY: Oxford University Press;1992
4. Accreditation Council for Graduate Medical Education. Pediatrics program requirements.2003 . Available at: www.acgme.org/acWebsite/RRC_320/320_prIndex.asp. Accessed May 10, 2005
5. Roberts KB. Education: critical issues in pediatrics and other health professions. In: Zuckerman B, ed. Pediatric Education in the 21st Century. New York, NY: Josiah Macey, Jr Foundation; 2004: 33–36
6. Darden PM, Ector W, Moran C, Quattlebaum TG. Comparison of continuity in a resident versus private practice. Pediatrics.2001; 108 :1263 –1268[Abstract/Free Full Text]

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PEDIATRICS (ISSN 1098-4275). ©2005 by the American Academy of Pediatrics

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This article has been cited by other articles:

				P. G. McBurney, K. K. Gustafson, and P. M. Darden Effect of 80-Hour Workweek on Continuity of Care Clinical Pediatrics, October 1, 2008; 47(8): 803 - 808. [Abstract] [PDF]

This Article Extract Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by McBurney, P. G. Articles by Darden, P. M. Search for Related Content PubMed PubMed Citation Articles by McBurney, P. G. Articles by Darden, P. M. Related Collections Office Practice Social Bookmarking                         What's this?