# Clinician Volume and Outcomes Among Patients Admitted to Nursing Homes for Postacute Care

## TL;DR

This study found that the number of patients a doctor or advanced practitioner sees in a nursing home does not affect patient outcomes like rehospitalization or discharge success.

## Contribution

The study is one of the first to examine the relationship between clinician patient volume and postacute care outcomes in US nursing homes.

## Key findings

- No significant association was found between clinician panel size and rehospitalization rates.
- Patient outcomes like discharge success and functional improvement were not affected by clinician patient volume.
- Results suggest clinician workload does not impact postacute care quality in nursing homes.

## Abstract

Is the patient panel size of a physician or advanced practitioner associated with outcomes of patients admitted to nursing homes for postacute care?

In this cohort study, nursing home physician or advanced practitioner panel size was not associated with higher rates of rehospitalization, lower rates of successful discharge to community, or lower rates of functional improvement at discharge from postacute care in the nursing home.

These results suggest that nursing home physician and advanced practitioner panel size does not play a significant role in postacute care outcomes.

This cohort study of US patients in nursing homes who received postacute care examines the association of nursing home physician or advanced practitioner panel size and rates of rehospitalization, successful discharge to community, and functional improvement at discharge.

Little is known about the role of physician and advanced practitioner patient volume in postacute care outcomes in US nursing homes.

To examine the association between patient volume (the number of nursing home residents seen per year) and patient outcomes.

This cohort study used Medicare Part A and Part B claims and the nursing home minimum data set from 2012 to 2019. Eligible participants were Medicare fee-for-service beneficiaries aged 65 years or older who were admitted to a nursing home for postacute care and seen by a physician (internal medicine, family medicine, general practice, or geriatrics) or advanced practitioner (nurse practitioner or physician assistant) during their stay. The analyses were conducted between October 19, 2022, and June 6, 2025.

Treating clinician’s patient panel size.

Patient volume was measured by counting the number of unique patients seen by each clinician and categorized into deciles. Analyses were conducted at the patient-year level. Four risk-adjusted outcomes of care—30-day rehospitalization, emergency department (ED) visit, successful discharge to community, and improvement in functional status at discharge—were measured using Medicare’s quality measures specifications. Poisson regression models with nursing home–level random effects were used to measure the association between each outcome adjusted for patient risk factors and the decile of patient volume. The models also included nursing home characteristics and an indicator for year.

Of the 6 193 638 patient-years in the sample, 3 977 686 (64.2%) were of female and 2 215 952 (35.8%) of male participants; 548 241 patient-years (8.9%) were of Black and 5 376 750 (86.8%) of White participants. Patients of clinicians in the lowest decile of patient volume did not experience significantly different outcomes compared with those in the highest decile: the incidence rate ratio (IRR) was 1.05 (95% CI, 0.76-1.46) for rehospitalizations, 0.96 (95% CI, 0.86-1.07) for successful discharge to community, 1.03 (95% CI, 0.90-1.19) for ED visits, and 0.96 (95% CI, 0.88-1.40) for functional improvement at discharge from the nursing home.

In this cohort study of Medicare beneficiaries, we did not find an association between clinician panel size and nursing home postacute care outcomes. These findings may inform the design of care models for clinicians practicing in nursing homes.