Neil M. Paige, MD, MSHS *; Eric A. Apaydin, PhD, MPP, MS *; Jeremy D. Goldhaber-Fiebert, PhD; Selene Mak, PhD, MPH; Isomi M. Miake-Lye, PhD; Meron M. Begashaw, MPH; Jessica M. Severin, BS; Paul G. Shekelle, MD, PhD
Disclaimer: This manuscript is based on research conducted by the Evidence-based Synthesis Program Center located at the West Los Angeles VA Medical Center, Los Angeles, California, funded by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Quality Enhancement Research Initiative. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.
Financial Support: By the Veterans Affairs Quality Enhancement Research Initiative.
Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-2491.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Christina C. Wee, MD, MPH, Deputy Editor, reports employment with Beth Israel Deaconess Medical Center. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Yu-Xiao Yang, MD, MSCE, Deputy Editor, reports that he has no financial relationships or interest to disclose.
Reproducible Research Statement:Study protocol: Available from the VA Evidence Synthesis Program Coordinating Committee (e-mail, firstname.lastname@example.org). Statistical code: Not applicable. Data set: Available in reference 3 .
Corresponding Author: Neil M. Paige, MD, MSHS, West Los Angeles Veterans Affairs Medical Center, 11301 Wilshire Boulevard, Los Angeles, CA 90073; e-mail, email@example.com.
Current Author Addresses: Drs. Paige, Apaydin, Mak, Miake-Lye, and Shekelle; Ms. Begashaw; and Ms. Severin: West Los Angeles Veterans Affairs Medical Center, 11301 Wilshire Boulevard, Los Angeles, CA 90073.
Dr. Goldhaber-Fiebert: Stanford University School of Medicine, 615 Crothers Way, Encina Commons, Stanford, CA 94305-6006.
Author Contributions: Conception and design: N.M. Paige, E.A. Apaydin, P.G. Shekelle.
Analysis and interpretation of the data: N.M. Paige, E.A. Apaydin, J.D. Goldhaber-Fiebert, P.G. Shekelle.
Drafting of the article: N.M. Paige, E.A. Apaydin, J.D. Goldhaber-Fiebert, S. Mak, M.M. Begashaw, P.G. Shekelle.
Critical revision of the article for important intellectual content: N.M. Paige, E.A. Apaydin, J.D. Goldhaber-Fiebert, P.G. Shekelle.
Final approval of the article: N.M. Paige, E.A. Apaydin, J.D. Goldhaber-Fiebert, S. Mak, I.M. Miake-Lye, M.M. Begashaw, J.M. Severin, P.G. Shekelle.
Provision of study materials or patients: M.M. Begashaw.
Statistical expertise: J.D. Goldhaber-Fiebert.
Obtaining of funding: I.M. Miake-Lye, P.G. Shekelle.
Administrative, technical, or logistic support: S. Mak, I.M. Miake-Lye, M.M. Begashaw, J.M. Severin.
Collection and assembly of data: N.M. Paige, E.A. Apaydin, S. Mak, M.M. Begashaw, P.G. Shekelle.
Primary care for a panel of patients is a central component of population health, but the optimal panel size is unclear.
To review evidence about the association of primary care panel size with health care outcomes and provider burnout.
English-language searches of multiple databases from inception to October 2019 and Google searches performed in September 2019.
English-language studies of any design, including simulation models, that assessed the association between primary care panel size and safety, efficacy, patient-centeredness, timeliness, efficiency, equity, or provider burnout.
Independent, dual-reviewer extraction; group consensus rating of certainty of evidence.
Sixteen hypothesis-testing studies and 12 simulation modeling studies met inclusion criteria. All but 1 hypothesis-testing study were cross-sectional assessments of association. Three studies each provided low-certainty evidence that increasing panel size was associated with no or modestly adverse effects on patient-centered and effective care. Eight studies provided low-certainty evidence that increasing panel size was associated with variable effects on timely care. No studies assessed the effect of panel size on safety, efficiency, or equity. One study provided very-low-certainty evidence of an association between increased panel size and provider burnout. The 12 simulation studies evaluated 5 models; all used access as the only outcome of care. Five and 2 studies, respectively, provided moderate-certainty evidence that adjusting panel size for case mix and adding clinical conditions to the case mix resulted in better access.
No studies had concurrent comparison groups, and published and unpublished studies may have been missed.
Evidence is insufficient to make evidence-based recommendations about the optimal primary care panel size for achieving beneficial health outcomes.
Veterans Affairs Quality Enhancement Research Initiative.
Paige NM, Apaydin EA, Goldhaber-Fiebert JD, et al. What Is the Optimal Primary Care Panel Size?: A Systematic Review. Ann Intern Med. 2020;172:195–201. [Epub ahead of print 21 January 2020]. doi: https://doi.org/10.7326/M19-2491
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Published: Ann Intern Med. 2020;172(3):195-201.
Published at www.annals.org on 21 January 2020
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