title: Family Medicine Panel Size with Care Teams: Impact on Quality.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: From the Department of Family Medicine, Mayo Clinic, Rochester, MN (KBA, JLH, MEB, EWK, JM, TDT); the Department of Family Medicine, Mayo Clinic, Scottsdale, AZ (MMK, MLG, MJB); and the Department of Family Medicine, Mayo Clinic, Jacksonville, FL (FBW). angstman.kurt@mayo.edu.
authors.forename: Kurt B
authors.initials: KB
authors.lastname: Angstman
authors.affiliation: From the Department of Family Medicine, Mayo Clinic, Rochester, MN (KBA, JLH, MEB, EWK, JM, TDT); the Department of Family Medicine, Mayo Clinic, Scottsdale, AZ (MMK, MLG, MJB); and the Department of Family Medicine, Mayo Clinic, Jacksonville, FL (FBW).
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Horn
authors.affiliation: From the Department of Family Medicine, Mayo Clinic, Rochester, MN (KBA, JLH, MEB, EWK, JM, TDT); the Department of Family Medicine, Mayo Clinic, Scottsdale, AZ (MMK, MLG, MJB); and the Department of Family Medicine, Mayo Clinic, Jacksonville, FL (FBW).
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Bernard
authors.affiliation: From the Department of Family Medicine, Mayo Clinic, Rochester, MN (KBA, JLH, MEB, EWK, JM, TDT); the Department of Family Medicine, Mayo Clinic, Scottsdale, AZ (MMK, MLG, MJB); and the Department of Family Medicine, Mayo Clinic, Jacksonville, FL (FBW).
authors.forename: Molly M
authors.initials: MM
authors.lastname: Kresin
authors.affiliation: From the Department of Family Medicine, Mayo Clinic, Rochester, MN (KBA, JLH, MEB, EWK, JM, TDT); the Department of Family Medicine, Mayo Clinic, Scottsdale, AZ (MMK, MLG, MJB); and the Department of Family Medicine, Mayo Clinic, Jacksonville, FL (FBW).
authors.forename: Eric W
authors.initials: EW
authors.lastname: Klavetter
authors.affiliation: From the Department of Family Medicine, Mayo Clinic, Rochester, MN (KBA, JLH, MEB, EWK, JM, TDT); the Department of Family Medicine, Mayo Clinic, Scottsdale, AZ (MMK, MLG, MJB); and the Department of Family Medicine, Mayo Clinic, Jacksonville, FL (FBW).
authors.forename: Julie
authors.initials: J
authors.lastname: Maxson
authors.affiliation: From the Department of Family Medicine, Mayo Clinic, Rochester, MN (KBA, JLH, MEB, EWK, JM, TDT); the Department of Family Medicine, Mayo Clinic, Scottsdale, AZ (MMK, MLG, MJB); and the Department of Family Medicine, Mayo Clinic, Jacksonville, FL (FBW).
authors.forename: Floyd B
authors.initials: FB
authors.lastname: Willis
authors.affiliation: From the Department of Family Medicine, Mayo Clinic, Rochester, MN (KBA, JLH, MEB, EWK, JM, TDT); the Department of Family Medicine, Mayo Clinic, Scottsdale, AZ (MMK, MLG, MJB); and the Department of Family Medicine, Mayo Clinic, Jacksonville, FL (FBW).
authors.forename: Michael L
authors.initials: ML
authors.lastname: Grover
authors.affiliation: From the Department of Family Medicine, Mayo Clinic, Rochester, MN (KBA, JLH, MEB, EWK, JM, TDT); the Department of Family Medicine, Mayo Clinic, Scottsdale, AZ (MMK, MLG, MJB); and the Department of Family Medicine, Mayo Clinic, Jacksonville, FL (FBW).
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Bryan
authors.affiliation: From the Department of Family Medicine, Mayo Clinic, Rochester, MN (KBA, JLH, MEB, EWK, JM, TDT); the Department of Family Medicine, Mayo Clinic, Scottsdale, AZ (MMK, MLG, MJB); and the Department of Family Medicine, Mayo Clinic, Jacksonville, FL (FBW).
authors.forename: Tom D
authors.initials: TD
authors.lastname: Thacher
mesh_terms: D001071:Appointments and Schedules; D003920:Diabetes Mellitus / Q000628:therapy; D005194:Family Practice / Q000191:economics / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000191:economics / Q000706:statistics & numerical data*; D011787:Quality of Health Care / Q000191:economics / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires
keywords: Diabetes Mellitus; Family Physicians; Family Practice; Group Practice; Patient Care; Patient Satisfaction; Primary Health Care; Regression Analysis; Retrospective Studies