TY - JOUR
T1 - Acute Care Utilization by Patients After Graduation of Their Resident Primary Care Physicians
AU - Solomon, Sonja R.
AU - Gooding, Holly C.
AU - Reyes Nieva, Harry
AU - Linder, Jeffrey A.
N1 - Funding Information:
This work was funded by a Support for Excellence in Educational Development (SEED) Grant from the Brigham and Women’s Hospital Department of Medicine.
Publisher Copyright:
© 2015, Society of General Internal Medicine.
PY - 2015/11/1
Y1 - 2015/11/1
N2 - BACKGROUND: The disruption in provider continuity caused by medical resident graduation may result in adverse patient outcomes. OBJECTIVE: Our aim was to investigate whether resident graduation was associated with increased acute care utilization by residents’ primary care patients. DESIGN AND PARTICIPANTS: This was a retrospective cohort study of patients cared for by junior and senior residents finishing the academic year in 2010, 2011 and 2012. MAIN MEASURES: We compared rates of clinic visits, emergency department (ED) visits, and hospitalizations between transitioning patients whose residents were graduating and non-transitioning patients whose residents were not graduating. KEY RESULTS: Our study population comprised 90 residents, 4018 unique patients, and 5988 resident–patient dyads that transitioned (n = 3136) or did not transition (n = 2852). For transitioning patients, the clinic visit rate per 100 patients in the 4 months before and after graduation was 129 and 102, respectively; for non-transitioning patients, the clinic visit rate was 119 and 94, respectively (difference-in-differences, +2 per 100 patients; p = 0.12). For transitioning patients, the ED visit rate per 100 patients before and after graduation was 29 and 26, respectively; for non-transitioning patients, the ED visit rate was 28 and 25, respectively (difference-in-differences, 0; p = 0.49). For transitioning patients, the hospitalization rate per 100 patients before and after graduation was 14 and 13, respectively; for non-transitioning patients, the hospitalization rate was 15 and 12, respectively (difference-in-differences, −2; p = 0.20). In multivariable modeling there was no increased risk for transitioning patients for clinic visits (adjusted rate ratio [aRR], 1.03; 95 % confidence interval [CI], 0.97 to 1.10), ED visits (aRR, 1.05; 95 % CI, 0.92 to 1.20), or hospitalizations (aRR, 1.04; 95 % CI, 0.83 to 1.31). CONCLUSIONS: Acute care utilization by residents’ patients did not increase or decrease after graduation. Acute care utilization was high before and after graduation. Interventions to decrease the need for acute care should be employed throughout the year.
AB - BACKGROUND: The disruption in provider continuity caused by medical resident graduation may result in adverse patient outcomes. OBJECTIVE: Our aim was to investigate whether resident graduation was associated with increased acute care utilization by residents’ primary care patients. DESIGN AND PARTICIPANTS: This was a retrospective cohort study of patients cared for by junior and senior residents finishing the academic year in 2010, 2011 and 2012. MAIN MEASURES: We compared rates of clinic visits, emergency department (ED) visits, and hospitalizations between transitioning patients whose residents were graduating and non-transitioning patients whose residents were not graduating. KEY RESULTS: Our study population comprised 90 residents, 4018 unique patients, and 5988 resident–patient dyads that transitioned (n = 3136) or did not transition (n = 2852). For transitioning patients, the clinic visit rate per 100 patients in the 4 months before and after graduation was 129 and 102, respectively; for non-transitioning patients, the clinic visit rate was 119 and 94, respectively (difference-in-differences, +2 per 100 patients; p = 0.12). For transitioning patients, the ED visit rate per 100 patients before and after graduation was 29 and 26, respectively; for non-transitioning patients, the ED visit rate was 28 and 25, respectively (difference-in-differences, 0; p = 0.49). For transitioning patients, the hospitalization rate per 100 patients before and after graduation was 14 and 13, respectively; for non-transitioning patients, the hospitalization rate was 15 and 12, respectively (difference-in-differences, −2; p = 0.20). In multivariable modeling there was no increased risk for transitioning patients for clinic visits (adjusted rate ratio [aRR], 1.03; 95 % confidence interval [CI], 0.97 to 1.10), ED visits (aRR, 1.05; 95 % CI, 0.92 to 1.20), or hospitalizations (aRR, 1.04; 95 % CI, 0.83 to 1.31). CONCLUSIONS: Acute care utilization by residents’ patients did not increase or decrease after graduation. Acute care utilization was high before and after graduation. Interventions to decrease the need for acute care should be employed throughout the year.
KW - ambulatory care
KW - care transitions
KW - continuity of care
KW - medical education-graduate
KW - medical education-systems based practice
KW - utilization
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U2 - 10.1007/s11606-015-3305-7
DO - 10.1007/s11606-015-3305-7
M3 - Article
C2 - 25896089
AN - SCOPUS:84945436035
VL - 30
SP - 1611
EP - 1617
JO - Journal of General Internal Medicine
JF - Journal of General Internal Medicine
SN - 0884-8734
IS - 11
ER -