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Research ArticleOriginal Research

Family Medicine Panel Size with Care Teams: Impact on Quality

Kurt B. Angstman, Jennifer L. Horn, Matthew E. Bernard, Molly M. Kresin, Eric W. Klavetter, Julie Maxson, Floyd B. Willis, Michael L. Grover, Michael J. Bryan and Tom D. Thacher
The Journal of the American Board of Family Medicine July 2016, 29 (4) 444-451; DOI: https://doi.org/10.3122/jabfm.2016.04.150364
Kurt B. Angstman
the Department of Family Medicine, Mayo Clinic, Rochester, MN (KBA, JLH, MEB, EWK, JM, TDT); the Department of Family Medicine, Mayo Clinic, Scottsdale, AZ (MMK, MLG, MJB); and the Department of Family Medicine, Mayo Clinic, Jacksonville, FL (FBW).
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Jennifer L. Horn
the Department of Family Medicine, Mayo Clinic, Rochester, MN (KBA, JLH, MEB, EWK, JM, TDT); the Department of Family Medicine, Mayo Clinic, Scottsdale, AZ (MMK, MLG, MJB); and the Department of Family Medicine, Mayo Clinic, Jacksonville, FL (FBW).
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Matthew E. Bernard
the Department of Family Medicine, Mayo Clinic, Rochester, MN (KBA, JLH, MEB, EWK, JM, TDT); the Department of Family Medicine, Mayo Clinic, Scottsdale, AZ (MMK, MLG, MJB); and the Department of Family Medicine, Mayo Clinic, Jacksonville, FL (FBW).
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Molly M. Kresin
the Department of Family Medicine, Mayo Clinic, Rochester, MN (KBA, JLH, MEB, EWK, JM, TDT); the Department of Family Medicine, Mayo Clinic, Scottsdale, AZ (MMK, MLG, MJB); and the Department of Family Medicine, Mayo Clinic, Jacksonville, FL (FBW).
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Eric W. Klavetter
the Department of Family Medicine, Mayo Clinic, Rochester, MN (KBA, JLH, MEB, EWK, JM, TDT); the Department of Family Medicine, Mayo Clinic, Scottsdale, AZ (MMK, MLG, MJB); and the Department of Family Medicine, Mayo Clinic, Jacksonville, FL (FBW).
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Julie Maxson
the Department of Family Medicine, Mayo Clinic, Rochester, MN (KBA, JLH, MEB, EWK, JM, TDT); the Department of Family Medicine, Mayo Clinic, Scottsdale, AZ (MMK, MLG, MJB); and the Department of Family Medicine, Mayo Clinic, Jacksonville, FL (FBW).
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Floyd B. Willis
the Department of Family Medicine, Mayo Clinic, Rochester, MN (KBA, JLH, MEB, EWK, JM, TDT); the Department of Family Medicine, Mayo Clinic, Scottsdale, AZ (MMK, MLG, MJB); and the Department of Family Medicine, Mayo Clinic, Jacksonville, FL (FBW).
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Michael L. Grover
the Department of Family Medicine, Mayo Clinic, Rochester, MN (KBA, JLH, MEB, EWK, JM, TDT); the Department of Family Medicine, Mayo Clinic, Scottsdale, AZ (MMK, MLG, MJB); and the Department of Family Medicine, Mayo Clinic, Jacksonville, FL (FBW).
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Michael J. Bryan
the Department of Family Medicine, Mayo Clinic, Rochester, MN (KBA, JLH, MEB, EWK, JM, TDT); the Department of Family Medicine, Mayo Clinic, Scottsdale, AZ (MMK, MLG, MJB); and the Department of Family Medicine, Mayo Clinic, Jacksonville, FL (FBW).
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Tom D. Thacher
the Department of Family Medicine, Mayo Clinic, Rochester, MN (KBA, JLH, MEB, EWK, JM, TDT); the Department of Family Medicine, Mayo Clinic, Scottsdale, AZ (MMK, MLG, MJB); and the Department of Family Medicine, Mayo Clinic, Jacksonville, FL (FBW).
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Article Figures & Data

Figures

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  • Figure 1.
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    Figure 1.

    Effect of adjusted panel size on third appointment availability (days), controlling for patient complexity (P < .01).

  • Figure 2.
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    Figure 2.

    Effect of adjusted panel size on physician quality ranking, controlling for patient complexity (P = .03).

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    Figure 3.

    Effect of adjusted panel size on patient satisfaction, controlling for patient complexity (P = .42).

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    Figure 4.

    Effect of adjusted panel size on percentage daily fill rate, controlling for patient complexity (P = .06).

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    Figure 5.

    Effect of adjusted panel size on cost ranking, controlling for patient complexity (P = .24).

Tables

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    Table 1.

    Variables (Means) among Departmental Family Physicians

    VariablesPhysicians (N = 36)
    Panel size
        Nonadjusted1396 (768–1921)
        Adjusted for full-time equivalent2959 (1876–4828)
    Percentage of time spent in outpatient clinic49.25 (26.0–79.0)
    Panel complexity score0.818 (0.610–1.130)
    Patient satisfaction (% selecting top box)92.0 (65.2–100.0)
    Third available appointment (days)19 (1–63)
    Appointment fill rate (%)93.3 (79.0–98.0)
    • Data are mean (range).

    • View popup
    Table 2.

    Odds Ratio of Outcomes for Patient Satisfaction, Quality, Access, and Cost, by Panel Size

    N = 36Odds Ratio95% CIP Value
    Adverse outcomes*
        Patient satisfaction, ≤25th percentile1.610.28–9.25.07
        Quality rankings, ≤25th percentile7.611.13–51.46.04
        Third available appointment, >75th percentile10.911.36–87.26.03
        Cost rankings, >75th percentile0.230.04–1.31.10
        Daily fill rate, ≤25th percentile0.480.11–2.20.35
    Positive outcomes†
        Patient satisfaction, >75th percentile0.290.03–2.99.30
        Quality rankings, >75th percentile3.560.69–18.47.13
        Third available appointment, ≤25th percentile3.590.69–18.68.13
        Cost rankings, ≤25th percentile1.750.33–9.17.51
        Daily fill rate, >75th percentile0.000.00–0.00.10
    • ↵* If the adjusted panel contains >2959 patients.

    • ↵† If the adjusted panel contains <2496 patients.

    • CI, confidence interval.

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The Journal of the American Board of Family     Medicine: 29 (4)
The Journal of the American Board of Family Medicine
Vol. 29, Issue 4
July-August 2016
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Family Medicine Panel Size with Care Teams: Impact on Quality
Kurt B. Angstman, Jennifer L. Horn, Matthew E. Bernard, Molly M. Kresin, Eric W. Klavetter, Julie Maxson, Floyd B. Willis, Michael L. Grover, Michael J. Bryan, Tom D. Thacher
The Journal of the American Board of Family Medicine Jul 2016, 29 (4) 444-451; DOI: 10.3122/jabfm.2016.04.150364

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Family Medicine Panel Size with Care Teams: Impact on Quality
Kurt B. Angstman, Jennifer L. Horn, Matthew E. Bernard, Molly M. Kresin, Eric W. Klavetter, Julie Maxson, Floyd B. Willis, Michael L. Grover, Michael J. Bryan, Tom D. Thacher
The Journal of the American Board of Family Medicine Jul 2016, 29 (4) 444-451; DOI: 10.3122/jabfm.2016.04.150364
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