Estimating a Reasonable Patient Panel Size for Primary Care Physicians With Team-Based Task Delegation

被引:170
作者
Altschuler, Justin [1 ]
Margolius, David [1 ]
Bodenheimer, Thomas [1 ]
Grumbach, Kevin [1 ]
机构
[1] Univ Calif San Francisco, Dept Family & Community Med, Ctr Excellence Primary Care, San Francisco, CA 94110 USA
关键词
primary care; delegation; panels; health care team; allied health personnel; physician's practice patterns; models; organizational; practice-based research; UNITED-STATES; TIME; PREVALENCE;
D O I
10.1370/afm.1400
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
PURPOSE Primary care faces the dilemma of excessive patient panel sizes in an environment of a primary care physician shortage. We aimed to estimate primary care panel sizes under different models of task delegation to nonphysician members of the primary care team. METHODS We used published estimates of the time it takes for a primary care physician to provide preventive, chronic, and acute care for a panel of 2,500 patients, and modeled how panel sizes would change if portions of preventive and chronic care services were delegated to nonphysician team members. RESULTS Using 3 assumptions about the degree of task delegation that could be achieved (77%, 60%, and 50% of preventive care, and 47%, 30%, and 25% of chronic care), we estimated that a primary care team could reasonably care for a panel of 1,947, 1,523, or 1,387 patients. CONCLUSIONS If portions of preventive and chronic care services are delegated to nonphysician team members, primary care practices can provide recommended preventive and chronic care with panel sizes that are achievable with the available primary care workforce.
引用
收藏
页码:396 / 400
页数:5
相关论文
共 15 条
[1]   Physicians in retainer ("Concierge") practice: A national survey of physician, patient, and practice characteristics [J].
Alexander, GC ;
Kurlander, J ;
Wynia, MK .
JOURNAL OF GENERAL INTERNAL MEDICINE, 2005, 20 (12) :1079-1083
[2]  
*AM AC FAM PHYS, FACTS FAM MED
[3]   Confronting The Growing Burden Of Chronic Disease: Can The US Health Care Workforce Do The Job? [J].
Bodenheimer, Thomas ;
Chen, Ellen ;
Bennett, Heather D. .
HEALTH AFFAIRS, 2009, 28 (01) :64-74
[4]   Diabetes Prevalence and Therapeutic Target Achievement in the United States, 1999 to 2006 [J].
Cheung, Bernard M. Y. ;
Ong, Kwok Leung ;
Cherny, Stacey S. ;
Sham, Pak-Chung ;
Tso, Annette W. K. ;
Lam, Karen S. L. .
AMERICAN JOURNAL OF MEDICINE, 2009, 122 (05) :443-453
[5]   Will generalist physician supply meet demands of an increasing and aging population? [J].
Collwill, Jack M. ;
Cultice, James M. ;
Kruse, Robin L. .
HEALTH AFFAIRS, 2008, 27 (03) :W232-W241
[6]   US Trends in Prevalence, Awareness, Treatment, and Control of Hypertension, 1988-2008 [J].
Egan, Brent M. ;
Zhao, Yumin ;
Axon, R. Neal .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2010, 303 (20) :2043-2050
[7]   Trends in hypercholesterolemia, treatment and control among United States adults [J].
Ford, Earl S. ;
Li, Chaoyang ;
Pearson, William S. ;
Zhao, Guixiang ;
Mokdad, Ali H. .
INTERNATIONAL JOURNAL OF CARDIOLOGY, 2010, 140 (02) :226-235
[8]  
Klein S., 2011, VETERANS HLTH ADM IM
[9]   The quality of health care delivered to adults in the United States [J].
McGlynn, EA ;
Asch, SM ;
Adams, J ;
Keesey, J ;
Hicks, J ;
DeCristofaro, A ;
Kerr, EA .
NEW ENGLAND JOURNAL OF MEDICINE, 2003, 348 (26) :2635-2645
[10]   Is there time for management of patients with chronic diseases in primary care? [J].
Ostbye, T ;
Yarnall, KSH ;
Krause, KM ;
Pollak, KI ;
Gradison, M ;
Michener, JL .
ANNALS OF FAMILY MEDICINE, 2005, 3 (03) :209-214