Primary care physician panel size and quality of care: a population-based study in Ontario, Canada

Published: January 1, 2016
Category: Bibliography > Papers
Authors: Dahrouge S, Glazier RH, Hogg W, Muggah E, Russell G, Younger J
Countries: Canada
Language: null
Types: Care Management, Performance Analysis
Settings: Hospital

Ann Fam Med 14:26-33.

University of Ottawa, Ottawa, ON, Canada; Institute for Clinical Evaluative Sciences, Ottawa, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; Monash University, Clayton, Vic, Australia

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 increasig panel size (from 1,200 to 3,900). Eight chronic care indicatrs (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 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.

PMID: 26755780
PMCID: PMC4709152

Canada,Care Management,Practice Patterns Comparison,Chronic Disease Patients,Comprehensive Health Care/organization & administration,Comprehensive Health Care/statistics & numerical data,Continuity of Patient Care/standards,Continuity of Patient Care/statistics & numerical data,Cross-Sectional Studies,Databases,Factual,Disease Management,Early Detection of Cancer/statistics & numerical data,Fee-for-Service Plans,Gender,Health Services Accessibility/standards,Health Services Accessibility/statistics & numerical data,Middle Aged,Ontario,Primary Health Care/organization & administration,Primary Health Care/statistics & numerical data

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