Increasing Continuity While Promoting Patient Access in Academic Pediatric Primary Care

Authors

• Mary Carol Burkhardt, Division of General and Community Pediatrics (MC Burkhardt, D DeBlasio, WB Brinkman, L Lipps, T Huentelman, J Walters, T Wadley, and MN Jones), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics (MC Burkhardt, D DeBlasio, WB Brinkman, J Walters, T Wadley, and MN Jones), University of Cincinnati College of Medicine, Cincinnati, Ohio. Electronic address: mary.burkhardt@cchmc.org.
• Dominick DeBlasio, Division of General and Community Pediatrics (MC Burkhardt, D DeBlasio, WB Brinkman, L Lipps, T Huentelman, J Walters, T Wadley, and MN Jones), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics (MC Burkhardt, D DeBlasio, WB Brinkman, J Walters, T Wadley, and MN Jones), University of Cincinnati College of Medicine, Cincinnati, Ohio; Pediatric Residency Training Program (D DeBlasio and A Rossman), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
• William B. Brinkman, Division of General and Community Pediatrics (MC Burkhardt, D DeBlasio, WB Brinkman, L Lipps, T Huentelman, J Walters, T Wadley, and MN Jones), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics (MC Burkhardt, D DeBlasio, WB Brinkman, J Walters, T Wadley, and MN Jones), University of Cincinnati College of Medicine, Cincinnati, Ohio.
• Alexandra M. Corley, Division of General Pediatrics and Community Health (AMS Corley), Children's National Hospital, Washington, DC; Department of Pediatrics (AMS Corley), The George Washington University School of Medicine and Health Sciences, Washington, DC.
• Abigail Rossman, Pediatric Residency Training Program (D DeBlasio and A Rossman), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
• Lauren Lipps, Division of General and Community Pediatrics (MC Burkhardt, D DeBlasio, WB Brinkman, L Lipps, T Huentelman, J Walters, T Wadley, and MN Jones), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
• Tracy Huentelman, Division of General and Community Pediatrics (MC Burkhardt, D DeBlasio, WB Brinkman, L Lipps, T Huentelman, J Walters, T Wadley, and MN Jones), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
• Jessica Walters, Division of General and Community Pediatrics (MC Burkhardt, D DeBlasio, WB Brinkman, L Lipps, T Huentelman, J Walters, T Wadley, and MN Jones), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics (MC Burkhardt, D DeBlasio, WB Brinkman, J Walters, T Wadley, and MN Jones), University of Cincinnati College of Medicine, Cincinnati, Ohio.
• Tasha Wadley, Division of General and Community Pediatrics (MC Burkhardt, D DeBlasio, WB Brinkman, L Lipps, T Huentelman, J Walters, T Wadley, and MN Jones), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics (MC Burkhardt, D DeBlasio, WB Brinkman, J Walters, T Wadley, and MN Jones), University of Cincinnati College of Medicine, Cincinnati, Ohio.
• Margaret N. Jones, Division of General and Community Pediatrics (MC Burkhardt, D DeBlasio, WB Brinkman, L Lipps, T Huentelman, J Walters, T Wadley, and MN Jones), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics (MC Burkhardt, D DeBlasio, WB Brinkman, J Walters, T Wadley, and MN Jones), University of Cincinnati College of Medicine, Cincinnati, Ohio; Michael A. Fisher Child Health Equity Center (MN Jones), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.

Document Type

Journal Article

Publication Date

2-11-2026

Journal

Academic pediatrics

Volume

26

Issue

3

DOI

10.1016/j.acap.2026.103247

Keywords

access; pediatric resident training site; quality improvement; usual provider continuity

Abstract

OBJECTIVE: Continuity of care is important to high-quality care in pediatrics. We sought to improve continuity rates for young patients (12-24 months) in an academic pediatric primary care training site over 2 years, from 0.32 to 0.40, while maintaining exceptional patient access and prioritizing patient preference. METHODS: We conducted a quality improvement (QI) project at a practice serving ∼15,600 patients (81% Black, 4.5% Hispanic; 85.3% Medicaid enrolled). Our team identified key drivers and iteratively tested interventions, including parent interviews to understand family preferences, extending acceptable windows for scheduling when appointment was due, soliciting family preferences for continuity or access when scheduling, opening provider templates further in advance, and scheduling future appointments before discharge. RESULTS: We improved the usual provider for continuity for well visits in patients aged 12 to 24 months from 0.32 to 0.42 as our primary outcome measure. Our secondary outcome measure decreased from 71% to 54% of children who never experienced continuity. Our process measures also showed improvement: we increased providers entering disposition notes when a patient is due for the next visit from 62% to 88% of encounters and from 31% to 61% of patients leaving with a scheduled future appointment. Our balancing measures of the third-next available well-child check visit and no-show rate remained stable. CONCLUSIONS: Application of QI methods increased well-check continuity for young patients in an academic primary care practice while maintaining exceptional patient access and prioritizing patient preference.

APA Citation

Burkhardt, Mary Carol; DeBlasio, Dominick; Brinkman, William B.; Corley, Alexandra M.; Rossman, Abigail; Lipps, Lauren; Huentelman, Tracy; Walters, Jessica; Wadley, Tasha; and Jones, Margaret N., "Increasing Continuity While Promoting Patient Access in Academic Pediatric Primary Care" (2026). GW Authored Works. Paper 8725.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/8725

Department

Pediatrics