The effect of patient reassignment on future continuity in a pediatric resident continuity practice

Background: When residents complete their pediatric training, patients from their continuity practices in academic settings must be reassigned to eith er a known resident of their selection or an unknown, incoming intern. Objectives: To determine what antecedent factors were associated with patie nt reassignment to a known resident of their selection, whether such reassi gnment was associated with increased health care use, and what factors were associated with continuity with the new resident provider. Design: Nonconcurrent cohort study. Setting: Hospital-based resident continuity clinic practice. Participants: Patients of residents graduating in June 1993. Results: Seven hundred fifty-eight patients of 18 graduating residents requ ired reassignment: 86 patients (11%) were assigned to a resident colleague, defined as the study group. From the remaining 673 patients who were assig ned to unknown, incoming interns, a control group was randomly selected (n = 160), with approximately 2 patients for each study group subject. Looking at antecedent factors, study group patients were more likely to have chron ic medical problems and to have seen their graduating resident more often a nd more recently. Univariate analysis explored the consequent factors of he alth care use and found that study group patients were more likely to retur n for a visit and to make more visits with the new provider. Multiple logis tic regression analysis demonstrated that being in the study group, younger age at the original encounter with the graduating resident, and a shorter interval since the last visit with the graduating resident were all associa ted with increased continuity with the new resident. Conclusions: The method of patient reassignment at a continuity clinic was associated with chronic disease of the patient and regularity of visits wit h the graduating resident. Increased continuity with a new resident, as det ermined by multivariate analysis, was associated with the method of reassig nment, a younger age at first encounter with the graduating resident, and a shorter interval since the last visit with the graduating resident. This s tudy has implications at ambulatory sites where transitions occur.