title: Improving clinical access and continuity through physician panel redesign.
abstract: BACKGROUND
  Population growth, an aging population and the increasing prevalence of chronic disease are projected to increase demand for primary care services in the United States.
  
  
  OBJECTIVE
  Using systems engineering methods, to re-design physician patient panels targeting optimal access and continuity of care.
  
  
  METHODS
  We use computer simulation methods to design physician panels and model a practice's appointment system and capacity to provide clinical service. Baseline data were derived from a primary care group practice of 39 physicians with over 20,000 patients at the Mayo Clinic in Rochester, MN, for the years 2004-2006. Panel design specifically took into account panel size and case mix (based on age and gender).
  
  
  METHODS
  The primary outcome measures were patient waiting time and patient/clinician continuity. Continuity is defined as the inverse of the proportion of times patients are redirected to see a provider other than their primary care physician (PCP).
  
  
  RESULTS
  The optimized panel design decreases waiting time by 44% and increases continuity by 40% over baseline. The new panel design provides shorter waiting time and higher continuity over a wide range of practice panel sizes.
  
  
  CONCLUSIONS
  Redesigning primary care physician panels can improve access to and continuity of care for patients.
authors.affiliation: Department of Mechanical and Industrial Engineering, University of Massachusetts, Amherst, MA 01003, USA. hbalasubraman@ecs.umass.edu
authors.forename: Hari
authors.initials: H
authors.lastname: Balasubramanian
authors.forename: Ritesh
authors.initials: R
authors.lastname: Banerjee
authors.forename: Brian
authors.initials: B
authors.lastname: Denton
authors.forename: James
authors.initials: J
authors.lastname: Naessens
authors.forename: James
authors.initials: J
authors.lastname: Stahl
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001071:Appointments and Schedules; D003266:Continuity of Patient Care / Q000592:standards* / Q000639:trends; D005260:Female; D006297:Health Services Accessibility / Q000592:standards* / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D058007:Physicians, Primary Care / Q000592:standards* / Q000639:trends; D011320:Primary Health Care / Q000592:standards* / Q000639:trends; D055815:Young Adult