Continuity of Care Counts: Patient Satisfaction in Advanced Practice Clinician Fracture Clinics

Background: Trauma centers may utilize fracture clinics primarily staffed by advanced practice clinicians (APC) for management of basic fractures that typically require few visits. It is unclear if provider continuity is important in these brief health care encounters. The purpose of this study was to determine the association between continuity of care and patient satisfaction scores in APC-run urgent/fracture clinics. Methods: This was a retrospective IRB-approved study at a pediatric tertiary-care Level-1 trauma hospital. We reviewed prospectively collected Press Ganey data from 2021 to 2023 for acute injury/fracture patients seen in a pediatric orthopaedic fracture clinic, which is APC-staffed and physician-supervised. Demographic and clinical data were collected along with the results of 4 Press Ganey patient satisfaction survey items ( recommend provider , teamwork , recommend practice , overall rating ). Univariate and multivariable models were conducted to determine independent predictors of patient satisfaction, including the effect of continuity of care. Results: A total of 230 follow-up encounters were reviewed. Median age was 11 years (range, 0 to 17). The majority of patients were male (59%), White (75%), with a very high child opportunity index (72%). Patients who saw the same provider at follow-up had a higher proportion of top-box ratings compared with those who saw a different provider for 3 of 4 outcomes: 88% versus 76% for staff teamwork ( P =0.04), 94% versus 78% for recommend practice ( P =0.003), and 93% versus 76% for overall rating of care ( P =0.003). After adjusting for consistency of care, location, age, sex , child opportunity index, injury region, and geographical distance from clinic, the odds of receiving a top-box rating for recommend practice were 4.7 times higher ( P =0.004) and 3.8 times higher for overall rating ( P =0.002) for patients with continuity of care-provider. Conclusions: Continuity of APC care-provider has a positive impact on patient satisfaction in a pediatric fracture clinic, as patients who saw the same provider in successive follow-up visits. Demographic, geographic, and clinical factors had comparatively little effect on patient satisfaction. The provider remains a fundamental factor in patient experience. Level of Evidence: Level II.