Improving Clinical Access and Continuity through Physician Panel Redesign
- First Online:
- 284 Downloads
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.
Using systems engineering methods, to re-design physician patient panels targeting optimal access and continuity of care.
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).
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).
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.
Redesigning primary care physician panels can improve access to and continuity of care for patients.
KEY WORDSprimary care access continuity of care systems engineering
- 3.Institute for Healthcare Improvement. Available at: http://www.ihi.org/IHI/Topics/OfficePractices/Access/ (accessed May 19, 2010).
- 4.Strunk, B, Cunningham, P. Treading Water: Americans’ Access to Needed Medical Care, 1997–2001, Washington DC, Center for Studying Health Systems Change, March 2002, http://www.hschange.com/CONTENT/421/ (accessed May 19, 2010)
- 9.O’Hare CD, Corlett J. The outcomes of open-access scheduling. Fam Pract Manage. 2004;11(2):35–8.Google Scholar
- 10.van Uden CJT, Zwietering PJ, Hobma SO, et al. Follow-up care by patient's own general practitioner after contact with out-of-hours care. A descriptive study. BMC Fam Pract. 2005;6(23):1–10.Google Scholar
- 11.Murray, M., and Tantau, C. Same-day appointments: Exploding the access paradigm, Family Practice Management, 1999, http://www.aafp.org/fpm/20000900/45same.html (accessed May 19, 2010)
- 13.Green LV, Savin S, Murray M. Providing timely access to care: what is the right patient panel size? Joint Comm J Qual Patient Saf. 2007;33(4):211–18.Google Scholar
- 14.Murray, M., Davies, M., and Boushon, B. Panel size: How many patients can one doctor manage? Family Practice Management, 2007, http://www.aafp.org/fpm/20070400/44pane.html (accessed May 19, 2010)
- 15.O’Hare CD, Corlett J. The outcomes of open-access scheduling. Fam Pract Manage. 2004;11(2):35–8.Google Scholar
- 23.Birge JR, Louveaux F. Introduction to Stochastic Programming. New York: Springer; 1997.Google Scholar
- 24.Breiman L, Friedman JH, Olsen RA, et al. Classification and Regression Trees. Wadsworth International Group; 1984.Google Scholar
- 28.Aharonson-Daniel L, Paul RJ, Hedley AJ. Management of queues in out-patient departments: the use of computer simulation. J Manag Med. 1996;10:50–8, 3.Google Scholar