How Might Team Approaches to Care Affect Panel Size?

Article for Discussion

Altschuler J, Margolius D, Bodenheimer T, Grumbach KT. Estimating a reasonable patient panel size for primary care physicians with teambased task delegation. Ann Fam Med. 2012;10(5):396-400.

Discussion Tips

Team approaches to care are a centerpiece of the patient-centered medical home.² But how to develop teams is a challenge,³ as are who should be on the team and how sharing work among team members could affect panel size.^4,5 This article addresses how team approaches to care might affect the patient panel size for primary care physicians.

Discussion Questions

• What questions are asked by this study?

• How does this study advance beyond previous research and clinical practice on this topic? How are the study questions relevant for current efforts to reenergize family medicine and reform primary care?

• How strong is the study design for answering the question?

• What are the key assumptions and data sources? How do they affect your confidence in the findings?

• To what degree can the findings be accounted for by:

  1. How patients were selected, excluded, or lost to follow-up?

  2. How the main variables were measured?

  3. Confounding (false attribution of causality because 2 variables discovered to be associated actually are associated with a 3rd factor)?

  4. Chance?

  5. How the findings were interpreted?

• What are the main study findings?

• How comparable are the scenarios to your practice?

• How transportable are the findings?

• What contextual factors are important for interpreting the findings?

• How might this study change your practice? Policy? Education? Research?

• Who are the constituencies are for the findings, and how might they be engaged in interpreting or using the findings?

• What are the next steps in interpreting or applying the findings, and what researchable questions remain?