Family Medicine Panel Size with Care Teams: Impact on Quality

K. B. Angstman, J. L. Horn, M. E. Bernard, M. M. Kresin, E. W. Klavetter, J. Maxson, F. B. Willis, M. L. Grover, M. J. Bryan, T. D. Thacher
2016 Journal of the American Board of Family Medicine  
Purpose: The demand for comprehensive primary health care continues to expand. The development of team-based practice allows for improved capacity within a collective, collaborative environment. Our hypothesis was to determine the relationship between panel size and access, quality, patient satisfaction, and cost in a large family medicine group practice using a team-based care model. Methods: Data were retrospectively collected from 36 family physicians and included total panel size of
more » ... nel size of patients, percentage of time spent on patient care, cost of care, access metrics, diabetic quality metrics, patient satisfaction surveys, and patient care complexity scores. We used linear regression analysis to assess the relationship between adjusted physician panel size, panel complexity, and outcomes. Results: The third available appointments (P < .01) and diabetic quality (P ‫؍‬ .03) were negatively affected by increased panel size. Patient satisfaction, cost, and percentage fill rate were not affected by panel size. A physician-adjusted panel size larger than the current mean (2959 patients) was associated with a greater likelihood of poor-quality rankings (<25th percentile) compared with those with a less than average panel size ( odds ratio [OR], 7.61; 95% confidence interval [CI], 1.13-51.46). Increased panel size was associated with a longer time to the third available appointment (OR, 10.9; 95% CI, 1.36 -87.26) compared with physicians with panel sizes smaller than the mean. Conclusions: We demonstrated a negative impact of larger panel size on diabetic quality results and available appointment access. Evaluation of a family medicine practice parameters while controlling for panel size and patient complexity may help determine the optimal panel size for a practice. (J Am Board Fam Med 2016;29:444 -451.) Appointment fill rate (%) 93.3 (79.0-98.0) Data are mean (range).
doi:10.3122/jabfm.2016.04.150364 pmid:27390375 fatcat:qzqrelfttfdzrhveepuzioxqau