Comparison of continuity in a resident versus private practice

Background. There is widespread agreement among pediatric educators that co ntinuity (following a panel of patients on a first contact basis for all th eir health care) is an important part of the education of pediatricians. Objective. To measure continuity in a pediatric residency practice and to c ompare this continuity with 2 nearby private general pediatric group practi ces. We also examined measures of continuity suggested in the literature. Design. Visit data were obtained from the practice billing system for a res ident continuity practice and 2 nearby private practices for the 3-year per iod from July 1, 1992, to June 30, 1995. Visit data used were restricted to patients seen in the office of the practices during regular office hours. Continuity was measured using 5 different indices: 1) the usual provider of care index, visits by the usual clinician/total visits, 2) continuity for patient, the average proportion of visits that an individual patient was se en by his or her own physician, 3) continuity for physician (PHY), the aver age proportion of visits that an individual physician saw his or her own pa tients, 4) Continuity of Care Index (COC), and 5) the Modified, Modified Co ntinuity Index. During the period examined, pediatric residents were presen t in the continuity practice for 1 half-day each week. The resident continu ity practice (RCP) had 57 residents and saw 3386 patients for 18 955 visits . Private practice 1 (PP1) had 4 pediatricians who saw 4968 patients for 33 537 visits. Private practice 2 (PP2) had 5 pediatricians who saw 11 953 pa tients for 75 778 visits. Results. For all visit types, continuity in the RCP was not as high as in t he private practices, PHY-RCP versus PP1, PP2; 53% versus 70%, 77%. However , continuity in RCP was greater than 50% for all measures except the COC in dex, which precipitously decreases as the number of clinicians seen increas es. Examining continuity for health maintenance visits (PHY-RCP, PP2 vs PP1 ; 96%, 96% vs 82%) RCP was equal to the best of the private practices. The percentage of patients not seen for a health maintenance visit during the s tudy period was lowest in the resident practice (RCP/PP1/PP2, 15/22/30). Conclusion. Although continuity for all visits in this RCP was less than in private practice, it was surprisingly high, considering the limited time r esidents spend in clinic. In a particularly important area for continuity, health maintenance visits, continuity was identical to one and superior to the other private practice.