TY - JOUR
T1 - Primary care physician panel size and quality of care
T2 - A population-based study in Ontario, Canada
AU - Dahrouge, Simone
AU - Hogg, William
AU - Younger, Jaime
AU - Muggah, Elizabeth
AU - Russell, Grant Mervyn
AU - Glazier, Richard H
PY - 2016
Y1 - 2016
N2 - PURPOSE: The purpose of this study was to determine the relationship between the number of patients under a primary care physician’s care (panel size) and primary care quality indicators.METHODS: We conducted a cross-sectional, population-based study of fee-forservice and capitated interprofessional and non-interprofessional primary healthcare practices in Ontario, Canada between April 2008 and March 2010, encompassing 4,195 physicians with panel sizes ≥1,200 serving 8.3 million patients. Data was extracted from multiple linked, health-related administrative databases and covered 16 quality indicators spanning 5 dimensions of care: access, continuity,comprehensiveness, and evidence-based indicators of cancer screening and chronic disease management.RESULTS: The likelihood of being up-to-date on cervical, colorectal, and breast cancer screening showed relative decreases of 7.9% (P <.001), 5.9% (P = .01),and 4.6% (P <.001), respectively, with increasing panel size (from 1,200 to 3,900). Eight chronic care indicators (4 medication-based and 4 screening-based)showed no significant association with panel size. The likelihood of individuals with a new diagnosis of congestive heart failure having an echocardiogram, however,increased by a relative 8.1% (P <.001) with higher panel size. Increasing panel size was also associated with a 10.8% relative increase in hospitalization rates for ambulatory-care–sensitive conditions (P = .04) and a 10.8% decrease in non-urgent emergency department visits (P = .004). Continuity was highest with medium panel sizes (P <.001), and comprehensiveness had a small decrease(P = .03) with increasing panel size.CONCLUSIONS: Increasing panel size was associated with small decreases in cancer screening, continuity, and comprehensiveness, but showed no consistent relationships with chronic disease management or access indicators. We found no panel size threshold above which quality of care suffered.
AB - PURPOSE: The purpose of this study was to determine the relationship between the number of patients under a primary care physician’s care (panel size) and primary care quality indicators.METHODS: We conducted a cross-sectional, population-based study of fee-forservice and capitated interprofessional and non-interprofessional primary healthcare practices in Ontario, Canada between April 2008 and March 2010, encompassing 4,195 physicians with panel sizes ≥1,200 serving 8.3 million patients. Data was extracted from multiple linked, health-related administrative databases and covered 16 quality indicators spanning 5 dimensions of care: access, continuity,comprehensiveness, and evidence-based indicators of cancer screening and chronic disease management.RESULTS: The likelihood of being up-to-date on cervical, colorectal, and breast cancer screening showed relative decreases of 7.9% (P <.001), 5.9% (P = .01),and 4.6% (P <.001), respectively, with increasing panel size (from 1,200 to 3,900). Eight chronic care indicators (4 medication-based and 4 screening-based)showed no significant association with panel size. The likelihood of individuals with a new diagnosis of congestive heart failure having an echocardiogram, however,increased by a relative 8.1% (P <.001) with higher panel size. Increasing panel size was also associated with a 10.8% relative increase in hospitalization rates for ambulatory-care–sensitive conditions (P = .04) and a 10.8% decrease in non-urgent emergency department visits (P = .004). Continuity was highest with medium panel sizes (P <.001), and comprehensiveness had a small decrease(P = .03) with increasing panel size.CONCLUSIONS: Increasing panel size was associated with small decreases in cancer screening, continuity, and comprehensiveness, but showed no consistent relationships with chronic disease management or access indicators. We found no panel size threshold above which quality of care suffered.
UR - http://www.annfammed.org/content/14/1/26.full.pdf
U2 - 10.1370/afm.1864
DO - 10.1370/afm.1864
M3 - Article
SN - 1544-1709
VL - 14
SP - 26
EP - 33
JO - Annals of Family Medicine
JF - Annals of Family Medicine
IS - 1
ER -