665 RESIDENTS' CONTINUITY CLINICS: AN EFFECT ON SUBSPECIALTY UTILIZATION

Abstract

As a part of ambulatory pediatric training, a resident must learn to provide general care and to seek subspecialty consultation where appropriate. Traditional training programs have fallen short in teaching this skill and have often encouraged patients to be followed in subspecialty clinics. A resident-staffed continuity clinic could be expected to influence both these factors in the direction of decreasing inappropriate subspecialty utilization. To test this hypothesis we measured pediatric and non-pediatric subspecialty clinic utilization rates before and after the introduction of a resident-staffed primary care continuity clinic. Utilization rates (the number of specialty clinic visits per 1000 general pediatric visits) were calculated for comparable six month periods before and after the intervention. There was a significant decrease in pediatric specialty utilization rates from 1.88/1000 to 1.26/1000, X² = 13.81 P<.001. Non-pediatric subspecialty clinic utilization also decreased, but at a non-significant level. To exclude any bias introduced by variation in illness level in the patient population, the total hospitalization days and hospitalization rates for certain indicator conditions were analyzed and no significant differences before or after the intervention were found. These results indicate that a resident-staffed primary care continuity clinic can reduce subspecialty utilization and suggest that the resident can learn to be more discriminating in his use of these services.

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