303 - Continuity of Care in Arkansas Children’s Primary Care Clinics and Opportunity for Improvement

Continuity of care is a basic building block of high quality primary care. It is associated with patient and provider satisfaction, improved outcomes and decreased costs of care. Arkansas Children’s primary care clinics all participate in centralized scheduling.

Objective:

To examine the continuity of care in Arkansas Children’s primary care clinics and how it varied between primary care clinics as well as for resident, attending and advance practice nurse (APRN).

Design/Methods: Data was obtained from the electronic medical record for patient visits occurring from 7/1/2019 to 6/30/2022. Continuity was calculated using the continuity of care index (COCI) of Bice and Boxerman (1977). Patients were included if they had at more than 2 visits. Because COCI was not normally distributed, comparisons were made by Kruskal-Wallis test.

Results:

Over the 3 years there were 161,486 visits by 37,727 patients. There were 22,051 patients with at least 3 visits who made 139,356 visits (mean/median visits 6.32/5.0). The overall COCI was 0.16 (median 0.07). In the table below are the COCI by clinic and within clinic for well checks and for type of clinician. Continuity of care varied significantly by clinic (Table) and race (Black/White/Other 0.12/0.17/0.20: P< .05) of patient. Pediatric residents in continuity clinic demonstrated the most variability in continuity (Table) and were significantly lower than Attending or APRN.

Conclusion(s):

Despite having centralized scheduling, Arkansas Children’s primary care clinics differ in their continuity of care, with residents continuity clinic among the lowest. These clinics continuity of care measures demonstrate opportunities for improvement. We will use this data to inform empanelment of patients and to develop administrative procedures to support continuity of care with special attention to resident continuity.