Date

April 2012

Document Type

Thesis

Degree Name

M.P.H

Department

Dept. of Public Health and Preventive Medicine

Institution

Oregon Health & Science University

Abstract

Purpose: The numerous benefits of interpersonal continuity in primary care practice are well described in the literature. Our analysis assessed the association between provider practice features and interpersonal continuity using the Usual Provider Continuity Index (UPC: the ratio of the number of patient visits with their personal primary provider divided by total patient visits to the clinic). Methods: We conducted a sequential explanatory mixed-methods study of the effects of several provider practice parameters on UPC in four university-based family medicine clinics. A retrospective cohort was used for quantitative analysis and provider focus groups were conducted to validate our quantitative aims. Data were extracted from monthly provider performance reports from July 1, 2009 to June 30, 2010. The unit of analysis was an individual primary care provider (n=63) from four academic family medicine clinics. We tested the effect of five practice parameters on UPC: (1) Clinic frequency; (2) Panel size; (3) Patient load (ratio of panel size to clinic frequency); (4) Attendance ratio; and (5) Duration in practice. Clinic, care team, provider gender and provider type (physician vs. mid-level) were analyzed as covariates. Simple and multiple linear regression were used for statistical modeling. Sequential thematic coding was used for qualitative analysis. Results: There were strong linear associations between UPC and both clinic frequency (β = 0.94; 95% CI 0.62, 1.27; p<0.0001) and patient load (β = -0.37; 95% CI -0.48, -0.26; p<0.0001). A multiple linear regression including clinic frequency, patient load, duration in practice and provider type explained over 60% of the variation in UPC (Adjusted R[superscript 2] = 0.629, p<0.0001). Focus groups identified six themes (clinic diversity, provider diversity, patient diversity, visit type, non-PCP continuity, absences) as other potential sources of variability in UPC. Conclusions: Variability in UPC between providers is largely a function of (1) how often a provider is in clinic; (2) sufficient clinic frequency to care for an assigned patient panel; and (3) maturity of practice. Future research should attempt to quantify additional sources of variability in UPC.

Identifier

doi:10.6083/M4TQ5ZJ5

School

School of Medicine

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