How does Panel Size impact Primary Care Physician level Continuity of Care?

Problem

Continuity of care (CoC) between patients and their primary care physician (PCP) is essential for effective primary care. Whether larger patient panels form a barrier to timely access to appointments and hinder CoC attainment has not been thoroughly studied in the United States, where physician level continuity measurement remains fairly novel and nascent. We used a large secondary claims database and recently endorsed measure of physician-level CoC to determine the relationship between CoC and panel size.

Approach

This cross-sectional analysis utilized 2019 Virginia All Payer Claims Data (APCD) to investigate the association between panel size and CoC among Medicare patients. Patients were attributed to their primary PCP using a proprietary methodology, and CoC was measured using the Bice-Boxerman Continuity of Care (BB-COC) index. Panel size was defined in two ways: by attribution method (counting patients attributed to each PCP) and unique patient method (counting patients having any PC visit with the PCP). Logistic regressions were performed, adjusting for patient and PCP covariates, with random intercepts at the PCP level.

Findings

Analysis included 533,583 patients attributed to 2,988 PCPs with 2,855,004 PC visits. PCPs had a median panel size of 593 by attribution and 820 by unique patients. The mean BB-COC score was 0.56, with 52% of patients exhibiting high CoC. There was no significant association between CoC and panel size by attribution. However, a significant association was observed with panel size by unique patients. Patients attributed to PCPs with panel sizes in the bottom quartile had a 60% high CoC rate compared to 49% in the top quartile, with an adjusted odds ratio of 2.32.

Consequences

This study highlights the importance of panel size in achieving higher CoC, particularly when considering all unique patients rather than solely attributed ones. Physicians managing smaller panels demonstrated significantly higher CoC rates. Monitoring patient volume and ensuring timely access to care could enhance CoC between patients and their PCPs. These findings underscore the need for healthcare systems to consider optimal panel sizes to facilitate better patient-physician relationships and improve primary care outcomes