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Physician panel size has no effect on quality of care

Increasing the number of patients under a primary care physician’s charge is associated with small decreases in cancer screening, continuity and comprehensiveness, yet it showed no consistent relationship with chronic disease management or access indicators, and had no negative effect on quality of care, according to a study published in the Annals of Family Medicine.

“Establishing the ‘ideal’ panel size for a primary care physician, by striking a balance between population access and quality of care, is a key objective for decision makers and clinicians,” Simone Dahrouge, PhD, of the C.T. Lamont Primary Health Care Research Centre, at the Bruyère Research Institute, in Ottawa, Ontario, Canada, and colleagues wrote. “Setting a maximum size or range, however, is challenging because quality of care can be influenced by a large number of patient, provider and contextual factors.”

To determine the relationship between a primary care physician’s panel size and quality of care indicators, the researchers conducted a cross-sectional, population-based study of fee-for-service practices, and capitated interprofessional and non-interprofessional practices in Ontario, Canada. The study included 4,195 primary care physicians with panel sizes of 1,200 or more, for a total number of 8.3 million patients.

Between April 2008 and March 2010, the researchers analyzed data from multiple linked, health-related administrative sources, including the Corporate Provider Database, covering 16 quality indicators spanning five dimensions of care: Access, continuity, comprehensiveness, cancer screening and chronic disease management.

According to the researchers, the likelihood of a patient being up-to-date on cervical, colorectal and breast cancer screening showed relative decreases of 7.9%, 5.9% and 4.6%, respectively, with an increased panel size of 1,200 patients to 3,900. However, eight chronic care indicators — four medication-based and four screening-based — showed no significant association with panel size. In addition, the likelihood of patients with a new diagnosis of congestive heart failure having an echocardiogram increased by a relative 8.1% with increased panel size. Higher panel size was also associated with a 10.8% relative increase in hospitalization rates for ambulatory-care-sensitive conditions, and a 10.8% decrease in nonurgent ED visits. Continuity was highest with medium panel sizes, and comprehensiveness saw a small decrease with increasing panel size.

“We postulate that physicians who take on larger patient panels may be able to do so without compromising care quality because some personal or practice characteristics allow them to provide effective and efficient care,” Dahrouge and colleagues wrote. “Characteristics such as physician communication style, better organizational climate and systematic improvements in practice access are reported to promote efficiency and/or quality.” – by Jason Laday