A comparison of the National Ambulatory Medical Care Survey (NAMCS) measurement approach with direct observation of outpatient visits.
80 and over; Adolescent; Adult; Aged; Ambulatory Care/*statistics & numerical data; Bias; Child; Family Practice/*statistics & numerical data; Female; Health Care Surveys/*methods/standards; Humans; Infant; Male; Middle Aged; Observation/*methods; Office Visits/*statistics & numerical data; Ohio; Preschool; Research Design/standards; Sensitivity and Specificity; Time Factors
BACKGROUND: The National Ambulatory Medical Care Survey (NAMCS) informs a wide range of important policy and clinical decisions by providing nationally representative data about outpatient practice. However, the validity of the NAMCS methods has not been compared with a reference standard. METHODS: Office visits of 549 patients visiting 30 family physicians in Northeastern Ohio were observed by trained research nurses. Visit content measured by direct observation was compared with data reported by physicians using the 1993 NAMCS form. RESULTS: Outpatient visit physician reports of procedures and examinations using the NAMCS method showed generally good concordance with direct observation measures, with kappas ranging from 0.39 for ordering a chest x-ray to 0.86 for performance of Pap smears. Concordance was generally lower for health behavior counseling, with kappas ranging from 0.21 for alcohol counseling to 0.60 for smoking cessation advice. The NAMCS form had high specificity (range, 0.90-0.99) but variable (range, 0.12-.84) sensitivity compared with direct observation, with the lowest sensitivities for health behavior counseling. The NAMCS physician report method overestimated visit duration in comparison with direct observation (16.5 vs. 12.8 minutes). CONCLUSIONS: Compared with direct observation of outpatient visits, the NAMCS physician report method is more accurate for procedures and examinations than for health behavior counseling. Underreporting of behavioral counseling and overreporting of visit duration should lead to caution in interpreting findings based on these variables.
Gilchrist Valerie J; Stange Kurt C; Flocke Susan A; McCord Gary; Bourguet Claire C
Medical care
2004
2004-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/01.mlr.0000114916.95639.af" target="_blank" rel="noreferrer noopener">10.1097/01.mlr.0000114916.95639.af</a>
Illuminating the `Black Box.'
PREVENTIVE health services; PRACTICE of medicine; FAMILY medicine; HOSPITAL records; MEDICAL care; PHYSICIAN-patient relations
BACKGROUND. The content and context of family practice outpatient visits have never been fully described, leaving many aspects of family practice in a "black box," unseen by policymakers and understood only in isolation. This article describes community family practices, physicians, patients, and outpatient visits. METHODS. Practicing family physicians in northeast Ohio were invited to participate in a multimethod study of the content of primary care practice. Research nurses directly observed consecutive patient visits, and collected additional data using medical record reviews, patient and physician questionnaires, billing data, practice environment checklists, and ethnographic fieldnotes. RESULTS. Visits by 4454 patients seeing 138 physicians in 84 practices were observed. Outpatient visits to family physicians encompassed a wide variety of patients, problems, and levels of complexity. The average patient paid 4.3 visits to the practice within the past year. The mean visit duration was 10 minutes. Fifty-eight percent of visits were for acute illness, 24% for chronic illness, and 12% for well care. The most common uses of time were history-taking, planning treatment, physical examination, health education, feedback, family information, chatting, structuring the interaction, and patient questions. CONCLUSIONS. Family practice and patient visits are complex, with competing demands and opportunities to address a wide range of problems of individuals and families over time and at various stages of health and illness. Multimethod research in practice settings can identify ways to enhance the competing opportunities of family practice to improve the health of their patients. [ABSTRACT FROM AUTHOR]
Stange Kurt C; Zyzanski Stephen J; JaƩn Carlos R; Callahan Edward J; Kelly Robert B; Gillanders William R; Shank Christopher J; Chao Jason; Medalie Jack H; Miller William L; Crabtree Benjamin F; Flocke Susan A; Gilchrist Valerie J; Langa Doreen M; Goodwin Meredith A
Journal of Family Practice
1998
1998-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1201/9781420040753.ch1" target="_blank" rel="noreferrer noopener">10.1201/9781420040753.ch1</a>