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Large patient panel size associated with negative impact on diabetic care

Large family physician patient panel size had a negative impact on diabetic quality results and available point of access, according to data published in the Journal of the American Board of Family Medicine.

However, the researchers found no association between panel size and appointment fill rates, costs or patient satisfaction.

“Demand for primary care services continues to increase as baby boomers age (with increased needs for both preventive care and chronic disease management),” Kurt B. Angstman, MS, MD, of the department of family medicine at the Mayo Clinic, in Rochester, Minnesota, and colleagues wrote. “Determining the size of the panel of patients that a family physician can care for has important implications, such as an impact on workforce staffing, quality outcomes and success to care.”

To determine the relationship between panel size and care access and quality, patient satisfaction and cost in a large primary care group practice using a team-based model, the researchers collected data from 36 family physicians at the Mayo Clinic in Rochester, Minnesota.

The researchers analyzed the physicians’ total panel sizes, the amount of time spent on patient care, cost of care, access metrics, diabetic quality metrics, patient satisfaction surveys, and patient care complexity scores. They used linear regression analysis to assess the association between adjusted panel size, complexity and outcomes.

According to the researchers, the mean panel size was 1,396 patients, with a range of 768 to 1,921. Time to third available appointment (P < .01) and quality of diabetic care (P = .03) were negatively impacted by increased panel size. Patient satisfaction, cost and percentage fill rate were not affected by panel size. However, a physician-adjusted panel size larger than the current mean — 2,959 patients — was associated with a greater likelihood of poor-quality rankings, defined as the 25th percentile or below, compared with those with a less than average panel size (OR = 7.61; 95% CI, 1.13-51.46).

“When adjusting for patient complexity, we found no relationship between family physician patient panel size and costs, appointment fill rates, or patient satisfaction,” Angstman and colleagues wrote. “We were able to demonstrate a negative impact of increasing panel size on diabetic quality results and available appointment access. Future care processes could be implemented to improve access and quality metrics while allowing increased panel growth. Evaluating family medicine practice parameters with this methodology while controlling for panel size and patient complexity may help guide practice change.” – by Jason Laday

Disclosure: The researchers report no relevant financial disclosures.