Improving clinical access and continuity through physician panel redesign.

Abstract

BACKGROUND: 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. OBJECTIVE: Using systems engineering methods, to re-design physician patient panels targeting optimal access and continuity of care. DESIGN: 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). MEASURES: 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). RESULTS: 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. CONCLUSIONS: Redesigning primary care physician panels can improve access to and continuity of care for patients.