A Simple Framework for Weighting Panels Across Primary Care Disciplines: Findings From a Large US Multidisciplinary Group Practice

Kamnetz, Sandra; Trowbridge, Elizabeth; Lochner, Jennifer; Koslov, Steven; Pandhi, Nancy

doi:10.1097/qmh.0000000000000190

Cited by 5 publications

(16 citation statements)

References 23 publications

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“…Title and abstract review identified 294 potentially relevant articles that underwent full text review, with 74 including relevant data. 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , ...…”

Section: Resultsmentioning

confidence: 99%

“…Table 2 shows the findings for rules for adding and removing patients from panels and the frequency of updating panel lists as reported by 29 different health care systems and 5 empanelment guides. 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 Details for each system or guide is provided in eTable 2 in the Supplement . Most organizations (29 [85.3%]) added patients to panels after 1 or more visits to primary care occurred (24 [70.6%] after 1 visit and 5 [14.8%] after several).…”

Section: Resultsmentioning

confidence: 99%

“…One factor affecting PCP resources is how the organization accounts for the contributions of APPs, which include nurse practitioners and physician assistants. 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 APPs can have independent panels; alternatively, patients they care for can be counted in panels of associated physicians. Seven organizations (20.6%) reported establishing independent panels for APPs, 7 (20.6%) reported that APPs shared panels with physicians, and 3 (8.8%) reported using both models.…”

Section: Resultsmentioning

confidence: 99%

“…The reported substitution ratios ranged from 0.5 to 1.0, as shown in Table 2 . 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50…”

Section: Resultsmentioning

confidence: 99%

“…We identified 28 articles that address whether panel was adjusted for CFTE or not (eTable 3 in the Supplement ). 8 , 9 , 10 , 11 , 12 , 16 , 19 , 27 , 31 , 34 , 37 , 38 , 39 , 40 , 41 , 43 , 44 , 45 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 Of these, 14 (50%) adjusted for the PCPs’ CFTE, but 14 (50%) reported panel size that was not adjusted for PCPs’ CFTE. Twenty-one of these articles (75.0%) also reported average panel sizes.…”

Section: Resultsmentioning

confidence: 99%

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Analysis of Variation in Organizational Definitions of Primary Care Panels

Mayo‐Smith

Robbins

Murray³

et al. 2022

JAMA Netw Open

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Key Points Question Is there variation in how organizations define primary care panels, and if so, how much does this contribute to variation in reported panel size? Findings This systematic review of 74 articles reporting on 29 health care systems and 5 empanelment implementation guides found wide variation in the rules used to add and remove patients from primary care panels and to count primary care resources. Different rules were associated with large differences in reported panel size, independent of the actual clinician workload. Meaning These findings suggest that caution is needed comparing reported panel sizes, and research is needed on the benefits of different approaches.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…The reported substitution ratios ranged from 0.5 to 1.0, as shown in Table 2 . 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Analysis of Variation in Organizational Definitions of Primary Care Panels

Mayo‐Smith

Robbins

Murray³

et al. 2022

JAMA Netw Open

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Physician Burnout and Timing of Electronic Health Record Use

Micek

Arndt

Tuan³

et al. 2020

ACI Open

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Background Rates of burnout among physicians have been high in recent years. The electronic health record (EHR) is implicated as a major cause of burnout. Objective This article aimed to determine the association between physician burnout and timing of EHR use in an academic internal medicine primary care practice. Methods We conducted an observational cohort study using cross-sectional and retrospective data. Participants included primary care physicians in an academic outpatient general internal medicine practice. Burnout was measured with a single-item question via self-reported survey. EHR time was measured using retrospective automated data routinely captured within the institution's EHR. EHR time was separated into four categories: weekday work-hours in-clinic time, weekday work-hours out-of-clinic time, weekday afterhours time, and weekend/holiday after-hours time. Ordinal regression was used to determine the relationship between burnout and EHR time categories. Results EHR use during in-clinic sessions was related to burnout in both bivariate (odds ratio [OR] = 1.04, 95% confidence interval [CI]: 1.01, 1.06; p = 0.007) and adjusted (OR = 1.07, 95% CI: 1.03, 1.1; p = 0.001) analyses. No significant relationships were found between burnout and after-hours EHR use. Conclusion In this small single-institution study, physician burnout was associated with higher levels of in-clinic EHR use but not after-hours EHR use. Improved understanding of the variability of in-clinic EHR use, and the EHR tasks that are particularly burdensome to physicians, could help lead to interventions that better integrate EHR demands with clinical care and potentially reduce burnout. Further studies including more participants from diverse clinical settings are needed to further understand the relationship between burnout and after-hours EHR use.

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Revitalizing Primary Care, Part 1: Root Causes of Primary Care’s Problems

Bodenheimer

2022

Ann Fam Med

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This 2-part essay offers a discussion of the health of primary care in the United States. Part 1 argues that the root causes of primary care's problems are (1) the low percent of national health expenditures dedicated to primary care (primary care spending) and (2) overly large patient panels that clinicians without a team are unable to manage, leading to widespread burnout and poor patient access.Information used in this essay comes from my personal clinical and policy experience bolstered by summaries of evidence. The analysis leans heavily on my visits to dozens of practices and interviews with hundreds of clinicians, practice leaders, and practice staff.In 2016, the United States spent approximately 5.4% of total health expenditures on primary care, compared with an average among 22 Organization for Economic Co-operation and Development (OECD) countries of 7.8%. With average US primary care panel size around 2,000, it would take a clinician without an effective team 17 hours per day to provide good care to that panel. Low primary care spending and excessive panel sizes are related because most medical students avoid careers featuring underfunded practices with unsustainable work-life balance.Over the past 20 years, many initiatives-explored in Part 2 of this essay-have attempted to address these problems. Part 2 argues that to revitalize primary care, 2 fundamental changes are needed: (1) increased spending dedicated to primary care and (2) creating powerful teams that add capacity to care for large panels.

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A Simple Framework for Weighting Panels Across Primary Care Disciplines: Findings From a Large US Multidisciplinary Group Practice

Cited by 5 publications

References 23 publications

Analysis of Variation in Organizational Definitions of Primary Care Panels

Analysis of Variation in Organizational Definitions of Primary Care Panels

Physician Burnout and Timing of Electronic Health Record Use

Revitalizing Primary Care, Part 1: Root Causes of Primary Care’s Problems

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