Improving clinical access and continuity through physician panel redesign.
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.
Balasubramanian
Hari
H
Department of Mechanical and Industrial Engineering, University of Massachusetts, Amherst, MA 01003, USA. hbalasubraman@ecs.umass.edu
Banerjee
Ritesh
R
Denton
Brian
B
Naessens
James
J
Stahl
James
J
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