Greater New York Hospital Association Foundation

Hospital-sponsored ambulatory clinics and outpatient departments are a major component of the primary care delivery system in the New York metropolitan region.

These clinics are training sites for thousands of physician residents in primary care specialties and serve a large number of the uninsured and Medicaid enrollees. Although medical residents gain useful experience, they are also a discontinuous workforce—requiring them to rotate through different departments and assignments, which in turn results in discontinuity of care for patients. In 2010, NYHealth awarded a planning grant to the Greater New York Hospital Association Foundation (GNYHA Foundation) to identify ways for improving quality and continuity of patient care while adequately training medical residents.

While hospital-sponsored outpatient clinics strive to improve the continuity of care they provide, they confront a unique structural difficulty because they serve as training sites for thousands of physician residents in primary care specialties. Each resident individually serves as a “discontinuous” member of the workforce and is required to be exposed to varying experiences, resulting in discontinuity for patients.

This planning grant reconciled two important missions: improving quality and continuity of care for patients while adequately training the next generation of physicians. Greater New York Hospital Association Foundation accomplished the following:

• Convened hospital administrators, ambulatory care directors, and residency program directors to assess the meaning of care management in the context of ambulatory teaching sites;
• Reviewed and evaluated compliance with accreditation requirements that impact care management;
• Identified opportunties to modify resident curriculm structures; and
• Identified the barriers to such modifications so that they can be overcome.