Busy primary-care practices can use computerized models to scrutinize their patient panel and determine changes that will allow them to significantly stretch capacity during a physician shortage, suggests a study by researchers at the University of Massachusetts Amherst, published in the current early online issue of the Journal of General Internal Medicine.
"We found that reorganizing the practice by reassigning patients from one physician to another or changing their panels actually improves timely access and continuity for patients with his or her own physician," Hari Balasubramanian, the study's lead author and the university's assistant professor of industrial engineering and systems engineer, told DOTmed News.
For the study, the researchers looked at the data on physician work schedules and patient appointments at the Mayo Clinic in Minnesota for the years 2004 to 2006. Using the data from a 39-physician primary-care group, the researchers analyzed wait times and continuity of care for more than 20,000 patients.
The team grouped the patients by gender and 14 different age groups and found that older patients tend to see their primary-care physician more frequently than patients younger than 35 years of age, regardless of gender, while females requested slightly more appointments in general.
By plugging the data into a computerized simulation of how the practice works, researchers determined that patient-panel tweaks could improve continuous patient access to their primary-care physicians by 40 percent and decrease the number of days patients wait for an appointment by up to 44 percent over baseline, cutting down the wait time from the average four to two days.
However, shuffling high-use patients to less-burdened doctors in a medical practice, as the study suggests, may be easier said than done. "That is very difficult to do in practice because there's an already established relationship but over time, you may be able to do it," Balasubramanian said. "That's why a computer model is useful, because it allows you to test something without actually doing it in practice."
Alternatively, physicians can simply be mindful of their ideal practice organization during the natural process of attrition. "You can use these changes to slowly get to the recommended case mix that the paper suggests," said Balasubramanian. "What I would say is that it has to be a slow change where you're continuously evaluating how you're doing, rather than an abrupt change just because the model suggests that there could be improvements."
To learn more:
- read the article in DOTmed News
- here's the abstract in the Journal of General Internal Medicine