1. Milestone 7 and Measuring Continuity
5/1/2018

2. Practice does not have a process in place to measure continuity.
Milestone 7
Practice has a process in place to measure and promote continuity so that patients and care teams recognize each other as partners in care.
Practice does not have a process in place to measure continuity.
Practice is starting to measure continuity but does not have systems in place to promote it.
Practice has introduced processes and systems for promoting continuity (e.g. scheduler scripts, patient cards with team member names and photos) but patients sometimes see providers other than their panel provider.
Practice has implemented processes to promote continuity and has the metrics to demonstrate that the processes are effective.

3. Primary Care Continuity
Read brief JAMA article (7 mins)
Review patient- and provider- centric measures of continuity. (8 mins)
Group discussion: questions, synergy with other milestones, application to practices (10-15 mins)

4. Reading (10 Mins)
Gupta R, Bodenheimer T. How Primary Care Practices Can Improve Continuity of Care. JAMA Intern Med.2013;173(20):1885–1886.

5. Patient-Centric Continuity Metric
Clinician
Empaneled Patients
Primary Care Visits to Empaneled Clinician
Primary Care Visits to any Clinician
Patient-Centric Continuity
T. Smith, MD
3500
7000
14000
0.5
R. Morton, CRNP
2500
7500
10000 ?
D. Hall, MD
3000
6000
9000

6. Provider-Centric Continuity Metric
Clinician
Empaneled Patients
Total Primary Care Visits
Primary Care Visits with Own Empaneled Patients
Patient-Centric Continuity
T. Smith, MD
3500
10000
6500
0.65
R. Morton, CRNP
2500
8000
6000 ?
D. Hall, MD
3000
5000

7. Group Discussion Potential Topics:
Questions about measurement or continuity
Synergy with other milestones or initiatives
Application to specific practices or situations