The Increasing Number of Clinical Items Addressed During the Time of Adult Primary Care Visits
The Increasing Number of Clinical Items Addressed During the Time of Adult Primary Care Visits
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DOI：
10.1007/s11606-008-0805-8
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发表时间：
2008-12-01
影响因子：
5.7
通讯作者：
Huang, Elbert S.
中科院分区：
文献类型：
--
作者：
Abbo, Elmer D.;Zhang, Qi;Huang, Elbert S.
背景技术背景：初级保健医生报告说，没有足够的时间来满足病人的需要，在临床访问，但访问时间增加了在过去decade.Objective：以确定是否有临床项目的数量增加了在初级保健访问，如果是这样，这是否已与变化的访问长度和临床工作的步伐。设计：1997年至2005年非医院成人初级保健就诊分析，如国家门诊医疗保健调查报告。参与者：共46，431名成人初级保健就诊。测量：我们评估了每次访视处理的临床项目总数（包括诊断、药物、检查和咨询）、访视持续时间和每个临床项目的平均可用时间随时间的变化。在调整后的分析中，我们控制了患者和医生的特征。结果：从1997年到2005年，每次就诊的临床项目数量从5.4增加到7.1（p < 0.001）。访视持续时间同时从18.0分钟增加到20.9分钟（p < 0.001）。临床项目数量的增加超过了持续时间的增加，导致每个临床项目的时间从4.4减少到3.8（p = 0.04）。这些变化发生在患者的年龄和付款状态，并确认在调整后的analysis.CONCLUSIONS：与初级保健访问相关的工作量增加到更大的程度比访问时间，导致可用时间更少，以解决个别项目。这些发现对补偿医生的时间和提高护理质量具有重要意义。
BACKGROUND: Primary care physicians report that there is insufficient time to meet patients' needs during clinical visits, but visit time has increased over the past decade.OBJECTIVE: To determine whether the number of clinical items addressed during the primary care visit has increased, and if so, whether this has been associated with changes in visit length and the pace of clinical work.DESIGN: Analysis of non-hospital-based adult primary care visits from 1997 to 2005, as reported in the National Ambulatory Medical Care Survey.PARTICIPANTS: A total of 46,431 adult primary care visits.MEASUREMENTS: We assessed changes over time for the total number of clinical items addressed per visit (including diagnoses, medications, tests ordered, and counseling), visit duration, and average available time per clinical item. In adjusted analyses we controlled for patient and physician characteristics.RESULTS: The number of clinical items addressed per visit increased from 5.4 to 7.1 from 1997 to 2005 (p < 0.001). Visit duration concurrently increased from 18.0 to 20.9 min (p < 0.001). The increase in the number of clinical items outpaced the increase in duration, resulting in a decrease in time per clinical item from 4.4 to 3.8 (p = 0.04). These changes occurred across patient age and payer status and were confirmed in adjusted analyses.CONCLUSIONS: The volume of work associated with primary care visits has increased to a greater extent than has visit duration, resulting in less available time to address individual items. These findings have important implications for reimbursing physician time and improving the quality of care.