Article Figures & Data
Tables
- Table 1
Estimated Panel Sizes Under Different Models of Physician Task Delegation to Nonphysician Team Members
Nondelegated Model (Panel=983) Delegated Model 1 (Panel=1,947) Delegated Model 2 (Panel=1,523) Delegated Model 3 (Panel=1,387) Type of Care Time Delegated % Hours per Patient/Year Time Delegated % Hours per Patient/Year Time Delegated % Hours per Patient/Year Time Delegated % Hours per Patient/Year Preventive 0 0.71 77 0.16 60 0.28 50 0.35 Chronic 0 0.99 47 0.53 30 0.70 25 0.75 Acute 0 0.36 0 0.36 0 0.36 0 0.36 Total – 2.06 – 1.04 – 1.33 – 1.46
Additional Files
The Article in Brief
Justin Altschuler , and colleagues
Background The average US primary care physician's panel size (number of patients) is 2,300 and is expected to increase. Under a traditional model of practice, that number is too large for delivering consistently high-quality of care. This study estimates panel sizes that might be reasonable if some primary care services are delegated to nonphysician team members.
What This Study Found If some preventive and chronic care services are delegated to nonphysician team members, primary care practices can provide recommended care with panel sizes that can be achieved using the available primary care workforce. Based on 3 assumptions about the degree of task delegation, a primary care team could care for a panel of 1,947, 1,523, or 1,397 patients.
Implications
- Replacement of physician-only care with team-based care will require a significant change in the culture and structure of primary care practice.
- High-functioning primary care teams have the potential to ensure access and quality for the nation's population and provide a reasonable work life for physicians and other team members.
Annals Journal Club
Sep/Oct 2012: How Might Team Approaches to Care Affect Panel Size?
The Annals of Family Medicine encourages readers to develop a learning community of those seeking to improve health care and health through enhanced primary care. You can participate by conducting a RADICAL journal club and sharing the results of your discussions in the Annals online discussion for the featured articles. RADICAL is an acronym for Read, Ask, Discuss, Inquire, Collaborate, Act, and Learn. The word radical also indicates the need to engage diverse participants in thinking critically about important issues affecting primary care and then acting on those discussions.1
HOW IT WORKS
In each issue, the Annals selects an article or articles and provides discussion tips and questions. We encourage you to take a RADICAL approach to these materials and to post a summary of your conversation in our online discussion. (Open the article online and click on "TRACK Comments: Submit a response.") You can find discussion questions and more information online at: http://www.AnnFamMed.org/site/AJC/.
CURRENT SELECTION
Article for Discussion
- Altschuler J, Margolius D, Bodenheimer T, Grumbach KT. Estimating a reasonable patient panel size for primary care physicians with team-based 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:
- How patients were selected, excluded, or lost to follow-up?
- How the main variables were measured?
- Confounding (false attribution of causality because 2 variables discovered to be associated actually are associated with a 3rd factor)?
- Chance?
- 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?
References
- Stange KC, Miller WL, McLellan LA, et al. Annals Journal Club: It's time to get RADICAL. Ann Fam Med. 2006;4(3):196-197.
- Patient-Centered Primary Care Collaborative. The Patient-Centered Primary Care Collaborative. http://www.pcpcc.net/index.php. Accessed Aug 2, 2012.
- Miller WL, Crabtree BF, Nutting PA, Stange KC, Jaén CR. Primary care practice development: a relationship-centered approach. Ann Fam Med. 2010;8(Suppl 1):S68-S79.
- Reid RJ, Coleman K, Johnson EA, et al. The group health medical home at year two: cost savings, higher patient satisfaction, and less burnout for providers. Health Aff (Millwood). 2010;29(5):835-843.
- Kuzel AJ, Engel JD. Restoring Primary Care; Reframing Relationships and Redesigning Practice. Oxford: Radcliffe Publishing; 2011.
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