Modeling Family Medicine Provider Care Team Design to Improve Patient Care Continuity.

Background and objectives: Continuity of care is an integral aspect of high-quality patient care in primary care settings. In the Department of Family Medicine at Mayo Clinic, providers have multiple responsibilities in addition to clinical duties or panel management time (PMT). These competing time demands limit providers' clinical availability. One way to mitigate the impact on patient access and care continuity is to create provider care teams to collectively share the responsibility of meeting patients' needs.

Methods: This study presents a descriptive characterization of patient care continuity based on provider types and PMT. Care continuity was measured by the percentage of patient a ppointments s een by a provider in their o wn c are t eam (ASOCT) with the aim of reducing the variability of provider care team continuity. The prediction method is iteratively developed to illustrate the importance of the individual independent components. An optimization model is then used to determine optimal provider mix in a team.

Results: The ASOCT percentage in current practice among care teams ranges from 46% to 68% and the per team number of MDs varies from 1 to 5 while the number of nurse practitioners and physician assistants (NP/PAs) ranges from 0 to 6. The proposed methods result in the optimal provider assignment, which has an ASOCT percentage consistently at 62% for all care teams and 3 or 4 physicians (MDs) and NP/PAs in each care team.

Conclusions: The predictive model combined with assignment optimization generates a more consistent ASOCT percentage, provider mix, and provider count for each care team.