Journal of General Internal Medicine

, Volume 25, Issue 10, pp 1109–1115

Improving Clinical Access and Continuity through Physician Panel Redesign

  • Hari Balasubramanian
  • Ritesh Banerjee
  • Brian Denton
  • James Naessens
  • James Stahl
Original Research

DOI: 10.1007/s11606-010-1417-7

Cite this article as:
Balasubramanian, H., Banerjee, R., Denton, B. et al. J GEN INTERN MED (2010) 25: 1109. doi:10.1007/s11606-010-1417-7



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.


primary care access continuity of care systems engineering 

Copyright information

© Society of General Internal Medicine 2010

Authors and Affiliations

  • Hari Balasubramanian
    • 1
  • Ritesh Banerjee
    • 2
    • 5
  • Brian Denton
    • 3
  • James Naessens
    • 2
  • James Stahl
    • 4
  1. 1.Department of Mechanical and Industrial EngineeringUniversity of MassachusettsAmherstUSA
  2. 2.Division of Health Care Policy and Research, Department of Health Sciences ResearchMayo ClinicRochesterUSA
  3. 3.Department of Industrial and Systems EngineeringNorth Carolina State UniversityRaleighUSA
  4. 4.Department of Medicine, MGH Institute for Technology AssessmentMassachusetts General HospitalBostonUSA
  5. 5.Analysis Group, Inc.BostonUSA

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