Engaging Family Medicine Residents in a Structured Patient Panel Reassignment Process

Abstract

Background and Objectives: The patient panels of graduating residents must be reassigned by the end of residency. This process affects over 1 million patients annually within the specialty of family medicine. The purpose of this project was to implement a structured, year-end reassignment system in a family medicine residency program. Methods: Our structured reassignment process took place from December 2017 through June 2020. Panel lists of current, active patients were generated and residents were responsible for reassigning their own panels during a panel reassignment night. We created a tip sheet that addressed patient complexity and continuity, a risk stratification algorithm based on patients’ medical and social complexity, and a tool that tracked the number of patients assigned to each future provider. Outcome measures included a resident satisfaction survey administered in 2018-2020 and patient-provider continuity measured with a run chart from December 2016 through August 2020. Results: The resident survey response rate was 75%. Seventy-three percent felt the panel reassignment night was very helpful; 87% thought the reassignment timeline was extremely reasonable, and 87% indicated that they had the necessary information to reassign their patients. Residents also felt confident that their patients were reassigned appropriately (33% extremely confident, 67% somewhat confident). Patient continuity improved with a 13-point run above the median, indicating nonrandom variation. Patient continuity remained above the median until the impact of COVID-19 in April 2020. Conclusion: Our structured reassignment process was received positively by residents and resulted in improved patient continuity.

Analysis of Variation in Organizational Definitions of Primary Care Panels

“…Title and abstract review identified 294 potentially relevant articles that underwent full text review, with 74 including relevant data. 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , ...…”

“…Table 2 shows the findings for rules for adding and removing patients from panels and the frequency of updating panel lists as reported by 29 different health care systems and 5 empanelment guides. 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 Details for each system or guide is provided in eTable 2 in the Supplement . Most organizations (29 [85.3%]) added patients to panels after 1 or more visits to primary care occurred (24 [70.6%] after 1 visit and 5 [14.8%] after several).…”

“…As shown in Figure 1, the literature search yielded 1671 articles. Title and abstract review identified 294 potentially relevant articles that underwent full text review, with 74 including relevant data …”

“…Table 2 shows the findings for rules for adding and removing patients from panels and the frequency of updating panel lists as reported by 29 different health care systems and 5 empanelment guides . Details for each system or guide is provided in eTable 2 in the Supplement.…”

Continuity of Care: A Primer for Family Medicine Residencies

“…This process affects up to 1 million patients in the United States annually. 60 In the case of a clinic-first model, with approximately equal time in the FMP throughout residency, reassigning a graduating resident's panel to an incoming PGY1 resident is trivial. However, even in this situation, the program director may wish to engage in panel management as per ACGME requirements to balance the ages, genders, and…”