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

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.