Improving Infant Continuity of Care in an Academic Center Clinic: A Quality Improvement Project.

Abstract

Introduction: Continuity of care (COC) with an identified provider is a key principle of the patient-centered medical home. COC may be impacted by other activities that providers practicing in an academic center must engage in. The disruption of care processes during the COVID-19 pandemic led to a decrease in COC for infants attending our academic center's primary care clinic. We implemented a quality improvement (QI) project to improve the rates of infant COC.

Methods: In 2021, we implemented a QI project with the aim of increasing the percentage of 12-month-old infants who had seen the same provider for at least 3 of the recommended 6 well-child checks in infancy. QI methodology was used to determine root causes of the problem, which included access, scheduling, and the patient-provider relationship. Process measures included tracking scheduled future well checks for newborns and 4-month-old infants, as well as establishing a medical home provider. Multiple Plan-Do-Study-Act cycles were implemented, including scheduling well visits at newborn hospital discharge, scheduling by clinic nurses, and establishing the family's preferred medical home provider.

Results: The percentage of infants seeing the same provider for at least 3 well visits in the first year of life increased from a baseline of 9% in July 2021 to 60% in June 2023. This was sustained through December 2023.

Conclusions: An outpatient QI project to improve infant COC was successfully implemented with sustained outcomes. Next steps include evaluating the effect of these interventions on future continuity.