Simone Dahrouge1, William Hogg2, Jaime Younger3, Elizabeth Muggah4, Grant Russell5, Richard H Glazier6. 1. Department of Family Medicine, University of Ottawa, Canada C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Canada Institute of Population Health, University of Ottawa, Canada Department of Epidemiology and Community Medicine, University of Ottawa, Canada Institute of Clinical Evaluative Sciences, Ottawa, Canada sdahrouge@bruyere.org. 2. Department of Family Medicine, University of Ottawa, Canada C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Canada Institute of Population Health, University of Ottawa, Canada Department of Epidemiology and Community Medicine, University of Ottawa, Canada. 3. Institute of Clinical Evaluative Sciences, Ottawa, Canada Ottawa Hospital Research Institute, Ottawa, Canada. 4. Department of Family Medicine, University of Ottawa, Canada C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Canada. 5. Southern Academic Primary Care Research Unit. School of Primary Health Care, Monash University, Clayton, Australia. 6. Institute for Clinical Evaluative Sciences, Toronto, Canada Department of Family and Community Medicine, University of Toronto, Canada Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Canada Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, Canada.
Abstract
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-for-service and capitated interprofessional and non-interprofessional primary health care 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.
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-for-service and capitated interprofessional and non-interprofessional primary health care 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.
Authors: Michael J van den Berg; Dinny H de Bakker; Gert P Westert; Jouke van der Zee; Peter P Groenewegen Journal: BMC Health Serv Res Date: 2009-02-26 Impact factor: 2.655
Authors: Steven K Dobscha; Ruth Q Leibowitz; Jennifer A Flores; Melanie Doak; Martha S Gerrity Journal: Implement Sci Date: 2007-05-30 Impact factor: 7.327
Authors: Steven J Atlas; Richard W Grant; Timothy G Ferris; Yuchiao Chang; Michael J Barry Journal: Ann Intern Med Date: 2009-03-03 Impact factor: 25.391
Authors: William Hogg; Ahmed Kotb; Anna Chu; Peter Gozdyra; Atul Sivaswamy; Jiming Fang; Claire E Kendall; Jack Tu Journal: Can Fam Physician Date: 2022-09 Impact factor: 3.025
Authors: Mylaine Breton; Mélanie Ann Smithman; Nassera Touati; Antoine Boivin; Christine Loignon; Carl-Ardy Dubois; Kareen Nour; Catherine Lamoureux-Lamarche; Astrid Brousselle Journal: J Prim Care Community Health Date: 2018 Jan-Dec