Family Medicine Panel Size with Care Teams: Impact on Quality.
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 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.
['Angstman|Kurt B|KB|', 'Horn|Jennifer L|JL|', 'Bernard|Matthew E|ME|', 'Kresin|Molly M|MM|', 'Klavetter|Eric W|EW|', 'Maxson|Julie|J|', 'Willis|Floyd B|FB|', 'Grover|Michael L|ML|', 'Bryan|Michael J|MJ|', 'Thacher|Tom D|TD|']
D001071:Appointments and Schedules D003920:Diabetes Mellitus D005194:Family Practice D006297:Health Services Accessibility D006801:Humans D017060:Patient Satisfaction D011320:Primary Health Care D011787:Quality of Health Care D012189:Retrospective Studies D011795:Surveys and Questionnaires
Primary Health Care Patient Satisfaction Group Practice Family Physicians Patient Care Regression Analysis Diabetes Mellitus Family Practice Retrospective Studies