Clinician Care Team Composition and Health Care Utilization

Area of Science:

• Health Services Research
• Primary Care Medicine
• Healthcare Management

Background:

• Primary care teams are crucial for managing patient health.
• Understanding the impact of team composition on healthcare utilization is essential for optimizing care delivery.

Purpose of the Study:

• To investigate the association between the proportion of physicians on primary care teams and healthcare utilization (emergency department visits, hospital admissions, readmissions).
• To identify clinician and care team characteristics linked to increased healthcare utilization.

Main Methods:

• Retrospective analysis of administrative data from 420 family medicine clinicians (physicians, nurse practitioners/physician assistants) in an integrated health system.
• Data included 419,581 patients across 110 care teams in Midwestern communities.
• Primary outcomes measured were rates of emergency department visits, hospitalizations, and readmissions.

Main Results:

• The proportion of physician full-time equivalents on a team did not correlate with emergency department visits, hospitalizations, or readmissions.
• Higher patient panel complexity (Hierarchical Condition Category score) was associated with increased emergency department visits, hospitalizations, and readmissions.
• Nurse practitioners/physician assistants compared to physicians, urban settings, and fewer years in practice were associated with higher emergency department visit rates.

Conclusions:

• Care team composition (physician vs. nurse practitioner/physician assistant ratio) was not independently associated with healthcare utilization.
• Patient panel complexity is a significant driver of emergency department visits, hospitalizations, and readmissions.
• Differences in utilization between physician and nurse practitioner/physician assistant panels were primarily observed for emergency department visits.