Improving clinical access and continuity through physician panel redesign

J Gen Intern Med. 2010 Oct;25(10):1109-15. doi: 10.1007/s11606-010-1417-7. Epub 2010 Jun 12.


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.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Appointments and Schedules*
  • Continuity of Patient Care / standards*
  • Continuity of Patient Care / trends
  • Female
  • Health Services Accessibility / standards*
  • Health Services Accessibility / trends
  • Humans
  • Male
  • Middle Aged
  • Physicians, Primary Care / standards*
  • Physicians, Primary Care / trends
  • Primary Health Care / standards*
  • Primary Health Care / trends
  • Young Adult