family practice

Access to Continuity-Strategies for Symbiotic Improvement of Access and Continuity of Care

Nathan Hinkle — Tue, 04 Aug 2026 19:27:34 +0000

Date Added:

August 4, 2026

Journal/Publication:

The Journal of the American Board of Family Medicine

Publisher:

The American Board of Family Medicine

Publication Date:

July 28, 2026

Issue:

Volume:

Pages:

1-5

URL:

Access to Continuity-Strategies for Symbiotic Improvement of Access and Continuity of Care

Type:

Practice Management Reviews and Guidelines

Format:

Article

DOI (1):

https://doi.org/10.3122/jabfm.2026.260055R0

Keywords

MeSH

continuity of patient care

leadership

RPR Commentary: Suggestions about how to improve access and continuity simultaneously. James W. Mold, MD, MPH

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Family medicine and primary care face ongoing pressures for access, with demand for care overwhelming the capacity to deliver it. Common strategies to maximize access often operate to the exclusion or detriment of continuity of care. During the August 2025 Family Medicine Leadership Consortium meeting, rather than presuming a tradeoff between the two as inevitable, the proposition that family medicine is committed to improving access to continuity of care was put forth.

This article summarizes concepts and models for improving access that simultaneously preserve or elevate continuity of care. A full understanding of access requires nuanced data around demand and capacity at the day-to-day level. This data can be used to prioritize both access and continuity by incorporating both into appointment templates, right-sizing panels, and directing capacity to the times of greatest demand. Investing in innovative team models such as those incorporating upskilled medical assistants, or panels shared among small teams of physicians and advanced practice practitioners, allow expanded capacity to deliver access while maintaining continuity. Advanced access scheduling models build on foundations of managing demand and capacity to most efficiently match day-to-day visit capacity to demand and maximize access to the continuity clinician.

Improving access and continuity of care do not have to be a zero-sum game—by valuing and centering continuity among access interventions, healthcare systems can shift the paradigm between access and continuity from “either/or” to a symbiotic relationship, with access meaning access to continuity of care.

Author/s:

Kong, Marianna, Lin, Steven, Ramm, Jason D., Weir, Samuel, Newton, Warren P.

Evaluation of a Dragons' Den-inspired symposium to spread primary health care innovations in Quebec, Canada: a mixed-methods study using quality-improvement e-surveys

Saige Blanchard — Tue, 29 Mar 2022 05:00:00 +0000

Date Added:

March 29, 2022

Journal/Publication:

CMAJ Open

Publisher:

CMA Impact Inc.

Publication Date:

March 22, 2022

Issue:

Volume:

Pages:

E247-E254

URL:

Evaluation of a Dragons' Den-inspired symposium to spread primary health care innovations in Quebec, Canada: a mixed-methods study using quality-improvement e-surveys

Type:

Best Local Practices

Format:

Article

DOI (1):

https://doi.org/10.9778/cmajo.20200251

Keywords

PMID (1):

35318248

MeSH

An apparently effective way to spread innovation in primary care. James W. Mold, MD, MPH

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Background: On May 24, 2017, the Quebec College of Family Physicians held an innovation symposium inspired by the television show Dragons' Den, at which innovators pitched their innovations to Dragon-Facilitators (i.e., decision-makers) and academic family medicine clinical leads. We evaluated the effects of the symposium on the spread of primary health care innovations.

Methods: We conducted a mixed-methods evaluation of the symposium. We collected data related to Rogers' innovation-decision process using 3 quality-improvement e-surveys (distributed between May 2017 and February 2018). The first survey evaluated spread outputs (innovation discovery, intention to spread, improvements) and was sent to all participants immediately after the symposium. The second evaluated short-term spread outcomes (follow-ups, successes, barriers) and was sent to innovators 3 months after the symposium. The third evaluated medium-term spread outcomes (spread, perceived impact) and was sent to innovators and clinical leads 9 months after the symposium. We analyzed the data using descriptive statistics, content analysis and joint display.

Results: Fifty-one innovators, 66 clinical leads (representing 42 clinics) and 37 Dragon-Facilitators attended the symposium. The response rates for the surveys were 61% (82/134) for the immediate post-symposium survey of all participants; 68% (21/31) for the 3-month survey of innovators; and 49% (48/97) for the 9-month survey of clinical leads and innovators. Immediately after the symposium, clinical leads and Dragon-Facilitators reported a high likelihood of adopting an innovation (mean ± standard deviation 8.02 ± 1.63 on a 10-point Likert scale) and 87% (53/61) agreed that they had discovered innovations at the symposium. Nearly all innovators (95%, 20/21) intended to follow up with potential adopters. After 3 months, 62% (13/21) of innovators had followed up in some way. After 9 months, 72% of clinical leads (18/25) had implemented at least 1 innovation, and 52% of innovators (12/23) had spread or were in the process of spreading innovations.

Interpretation: The innovation symposium supported participants in achieving the early stages of spreading primary health care innovations. Replicating such symposia may help spread other health care innovations.

Author/s:

Smithman, M. A., Dumas-Pilon, M., Campbell, M. J., Breton, M.

Itchy vesicles

Bethie Seay — Sun, 17 Oct 2021 05:00:00 +0000

Date Added:

October 17, 2021

Journal/Publication:

MDedge

Publication Date:

October 14, 2021

Type:

Meta-analyses, Reviews, and Guidelines

A concise summary of the appearance, cause, and treatment of dermatitis herpetiformis.

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A 58-year-old man presented to the family medicine skin clinic with a 4-month history of intensely pruritic vesicles on his forehead, back, elbows, dorsum of his hands, and knees. The patient also reported lesions inside his mouth; however, they were not visible at the time of the office visit. He had a history of psoriasis and Graves disease and had recently been given a biopsy-confirmed diagnosis of celiac disease.

What’s your diagnosis?

Author/s:

Colom, M., Stulberg, D.

The 2020 Medicare Documentation, Coding, and Payment Update

Brian Desmarais — Fri, 03 Jan 2020 19:58:25 +0000

Date Added:

January 3, 2020

Journal/Publication:

Mayo

Publisher:

American Academy of Family Physicians

Publication Date:

December 12, 2019

URL:

The 2020 Medicare Documentation, Coding, and Payment Update

Type:

Practice Management Reviews and Guidelines

Format:

Article

Keywords

coding

MeSH

Centers for Medicare and Medicaid Services, U.S.

referral and consultation

abdominal pain

Records

Major changes in coding will occur in 2021, but this 2020 update is also important. James W. Mold, MD, MPH

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As usual, the new year brings changes in how doctors bill and get paid for the services they provide to Medicare patients. The reforms that will most affect family physicians’ pay aren’t coming until 2021, when several changes in evaluation and management (E/M) coding and payment are projected to result in a 12% increase for family medicine.1 But there are still a host of things family physicians should know for 2020, including new codes to help you get paid for interacting with patients via the internet and new codes that should help make chronic care management (CCM) more financially rewarding. The Centers for Medicare & Medicaid Services (CMS) is also continuing its quest to streamline documentation requirements and develop new payment models intended to reward quality instead of volume. This article summarizes the 2020 changes most relevant to family medicine. As always, private payers’ policies may differ, so consult with your billing staff to understand any important differences.

Author/s:

Moore, K., Mullins, A., Solis, E.

Practice Transformation Under the University of Colorado's Primary Care Redesign Model

Brian Desmarais — Wed, 21 Aug 2019 19:24:44 +0000

Date Added:

August 21, 2019

Journal/Publication:

Annals of Family Medicine

Publication Date:

August 12, 2019

Volume:

Pages:

S24-S32

URL:

Practice Transformation Under the University of Colorado's Primary Care Redesign Model

Type:

Practice Management Reviews and Guidelines

Format:

Article

DOI (1):

10.1370/afm.2424

Keywords

quality of care

Clinicians

MeSH

Polymerase Chain Reaction

primary health care

diabetes mellitus

community health services

Ambulatory Care Facilities

hypertension

early detection of cancer

Increasing the ratio of MAs to clinicians and expanding the roles of the MAs improved access, quality of care, and clinician experience without increasing overhead. James W. Mold, MD, MPH

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PURPOSE:

We compared the transformation experience of 2 family medicine practices that implemented the Primary Care Redesign (PCR) team-based model to improve access, quality, and experience without increasing cost. The University of Colorado's A.F. Williams Family Medicine clinic (pilot practice) implemented the model in February 2015, and a smaller, community-based practice (wave 2 practice) did so 2 years later, in February 2017.

METHODS:

The PCR model increased the ratio of medical assistants to clinicians from about 1:2 to 2.5:1 while expanding the role of the medical assistants, through enhanced rooming procedures, in-room support (eg, scribing), postclinician wrap-up, and in-basket assistance. We assessed access, clinical quality metrics, staffing costs, and clinician and staff experience and burnout for at least 7 months before and 42 months after the intervention.

RESULTS:

In the pilot practice, compared with preimplementation, there were improvements in total appointments and rates of hypertension control, colorectal cancer screening, and most diabetic quality metrics. In the wave 2 practice, total appointments increased slightly when clinicians were added pre-PCR and then increased substantially after implementation; initially variable hypertension control improved rapidly after implementation. The wave 2 practice's colorectal cancer screening improved gradually, then accelerated postimplementation, while diabetic metrics initially remained stable or declined, then improved postimplementation. New patient appointments began to increase for both practices in late 2015, but grew faster in the pilot practice under PCR. Over time, all experiential domains improved for clinicians; most remained stable for staff. Clinician burnout was reduced by at least one-half in both practices except during low staffing periods, which also adversely affected staff. After a ramp-up period, the number of staff hours per visit remained stable.

CONCLUSIONS:

The PCR model is associated with simultaneous improvements in quality, access, and clinician experience, as well as reductions in burnout, while maintaining staffing costs.

Author/s:

Smith, P.C., Lyon, C., English, A.F., Conry, C.

Terminating a Patient: Is It Time to Part Ways?

Jeffrey Wilson — Thu, 04 Apr 2019 17:58:17 +0000

Date Added:

April 4, 2019

Journal/Publication:

Family Practice Medicine

Publisher:

American Association of Family Practitioners

Publication Date:

September 1, 2005

Issue:

Volume:

Pages:

34-38

URL:

Terminating a Patient: Is It Time to Part Ways?

Type:

Practice Management Reviews and Guidelines

Format:

Article

Keywords

family practice

patients

PMID (1):

16218291

MeSH

physicians, family

family practice

Guidance from Family Practice Management on when and how to dismiss a patient from your practice. James W. Mold, MD, MPH

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Many family physicians chose the specialty of family medicine because of the value placed on the therapeutic relationship between the patient and the physician. When that relationship is significantly or repeatedly challenged, family physicians feel it deeply, and it’s not always clear how best to address the problem.

We have found that, when emotions are high, having a standardized process for dealing with these challenges makes it easier to take appropriate action. Our process provides patients with plenty of opportunities to reconsider their behavior and re-engage in the relationship, when appropriate, and it provides the physician and staff the assurance that comes with following a reasoned, consistent approach when difficult circumstances arise. If it becomes necessary to terminate the relationship, our approach describes how to do it without running afoul of payers’ guidelines.

While our system is not perfect, it has significantly improved our ability to set expectations and draw boundaries in an environment where some payers have very narrowly defined the circumstances under which termination is acceptable. The flow charts in this article are based on ones we have used with success in our health system. You can download them below and adapt them for use in your practice.

Author/s:

Willis, Deanna R., Zerr, Ann