THE IMPACT OF AN AMBULATORY FIRM SYSTEM ON QUALITY AND CONTINUITY OF CARE

The author assessed the effects on quality and continuity of care at a Veterans Affairs hospital as a result of its conversion to an interdi sciplinary firm system. Before the firm system was implemented, ambula tory care at the hospital was provided in two medicine clinic areas an d in one unscheduled ''walk-in'' clinic. Care for intercurrent illness es was frequently not coordinated. The staff from eight clinical servi ces were involved in restructuring into three, interdisciplinary firm teams. These firm teams were created without the addition of new staff . Quality was defined by patient satisfaction, staff satisfaction, re- admissions within 10 days of a hospital discharge, and length of visit . Continuity was defined by percentage of visits to the primary care t eam (defined as the physician or the physician paired with midlevel pr actitioner if applicable). Patient satisfaction increased from 4.43 to 4.84 (5-point Likert scale, P < .001). Staff satisfaction increased f rom 4.3 to 6.24 (7-point Likert scale, P < .001). Re-admissions within 10 days of hospital discharge decreased by 28% (P < .01). Length of v isit decreased by 9.5% (P < .0001). Continuity improved from 47% to 69 % of visits to the primary care team (P < .002). These results more th an justified the staff time needed to convert to a firm system.