Department of
Internal Medicine at Highland Hospital
A member of Alameda Health System

Primary Care Continuity Clinic


Welcome to Highland Adult Medicine Clinic! We are an academic safety net clinic dedicated to serving the needs of patients in Alameda County. Our clinic consists of over 80 providers, including approximately 50 residents. Over 8,000 patients receive their care from us and our mission is Caring, Healing, Teaching, Serving All. 

Clinic Structure

Our clinic is organized according to a team structure consisting of four practice teams. Team members include dedicated attending physicians, resident physicians, a NP or PA, a LVN, and eligibility clerks. Teams meet monthly to engage in team building, troubleshooting, and clinic quality improvement activities.

1. TEAMS IN CLINIC:

  • At any given point in time, 12 residents will be on the 'ambulatory week' (4 interns, 4 PGY2s and 4PGY3s).
  • For primary care weeks (week 1 and 4), 9 residents will be primary care, 3 residents will be categorical. Their K6 schedules will look identical.
  • This means for each ambulatory week, 3 members of each clinic team will be present.

Example: "Cohort GREEN" is in clinic week 1. The clinic teams present are:

PGY1 PGY1 PGY1 PGY1
PGY2 PGY2 PGY2 PGY2
PGY3 PGY3 PGY3 PGY3

2. TEAM "PODS"

Each colored team (e.g. red, yellow, blue, green) will function as a "POD" the week that they are in clinic.

  • Each POD includes the same-colored PGY1, PGY2 and PGY3 and assigned POD attending/preceptor and mid-level provider.
  • Interns/Residents will be asked to precept primarily with their team attending; if the attending is busy with an admission/there is a long wait, the other team attending can hear cases, if needed.
  • If one member of their pod is absent (on vacation, elective, etc.), the other 2 members of the POD will be asked to see their patients in rare emergencies.
  • If one member of the pod is running behind in clinic, other team members may be asked to help in rare circumstances.
  • In addition, when the PGY3 member graduates, their patients will be re-distributed amongst the new POD intern and the existing 2 members of the POD. This way, patients will have continuity over many years with the same three resident providers and ideally, the same precepting attending/mid-level provider.

Example: "POD red"

PGY 1
PGY 2
PGY 3

3. TEAM "BUDDY-SYSTEM"

  • Each intern/resident will be assigned to a “buddy system” of interns/residents who are on different ambulatory weeks from them. E.g. the PGY 1 on the red team from Cohort A will be buddied with the PGY 1 on the red team from Cohorts B, C and D.
  • Buddies function mostly to handle clinic follow-up work for weeks that each person is not in clinic.
  • Each group of “buddies” will be responsible for handling clinic follow-up for their partners who are not in clinic (e.g. reviewing labs, filling out forms, handling urgent follow-up issues) and will share a clinic provider box.
  • Buddies will NOT be responsible for seeing each other’s patients in order to maintain clinic continuity. Patients will only be seen by members of their POD or the mid-level provider on their team.

Example: The "red" PGY1s in each ambulatory week will work together to complete clinic follow-up work. The attending will be the same and can provide some assistance, back-up.

Week 1 Week 2 Week 3 Week 4
PGY 1 PGY 1 PGY 1 PGY 1
PGY 3 PGY 3 PGY 3 PGY 3

Structue of Clinic Session:

Panel Size and Clinic Scheduling Templates:

Provider Type Panel Size Clinic Template
Resident PGY 1/2/3: 70 +/- 10% patients
  • PGY 1: 4-5 patients per half day; 30 minute visits for new and return pts
  • PGY2: 5-6 patients per half day; 30 minute visits for new and return pts
  • PGY3: 6-7 patients per half day; 20 minute visits for new and return pts

 

Types of Clinics Offered in K6:

Clinic Name Description
Team Back-Up Clinic Physician-extender function, appropriate for focused problems. Ise when patient needs follow up sooner than provider has available openings.
Convenient Care Clinic 72 hour hold and release function. Use to address urgent problems when provider and team back-up have no available openings.
Pharmacy Chronic Care Clinical pharmacist-run clinic to manage uncontrolled HTN and diabetes. Focused on medication reconciliation, titration, and education.
Nurse Visit Clinic Nurse-run clinic to evaluate specific issues such as medication reconciliation, wound check, BP med titration, etc.
Health Psychology Warm Handoffs Behavioral health evaluations by psychology trainees; can address numerous issues and connect patients to longer-term care as needed.
Psychiatry Consult Clinic Psychiatrist to consult on complex psychiatric disease, titrate psychotropic medications, and provide short term treatment.
Nutrition Clinic Nutritionist to provide education and counseling to prevent or manage chronic disease.
Social Work Clinic LCSW to evaluate psychosocial, financial, legal, and other non-medical needs and provide linkage to resources.
Pap Clinic Licensed provider to perform pap smears for K6 Adult Medicine patients.
Procedure Clinic Resident-run, attending-supervised procedure clinic to perform joint injections, skin biopsies, paracentesis, and pap smears for K6 patients.
Provider Clinic MD/DO/NP/PA primary care continuity clinic.