Illuminating the 'Black Box': A description of 4454 patient visits to 138 family physicians
Illuminating the 'Black Box': A description of 4454 patient visits to 138 family physicians
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发表时间：
1998-05
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通讯作者：
K. Stange;S. Zyzanski;C. Jaén;E. Callahan;R. Kelly;R. Kelly;W. Gillanders;J. C. Shank;J. Chao;J. Medalie;W. Miller;B. Crabtree;S. Flocke;V. Gilchrist;D. Langa;M. Goodwin
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作者：
K. Stange;S. Zyzanski;C. Jaén;E. Callahan;R. Kelly;R. Kelly;W. Gillanders;J. C. Shank;J. Chao;J. Medalie;W. Miller;B. Crabtree;S. Flocke;V. Gilchrist;D. Langa;M. Goodwin
家庭门诊就诊的内容和背景从未被充分描述过，使家庭门诊的许多方面处于“黑盒子”中，政策制定者看不到，只能孤立地理解。这篇文章描述了社区家庭实践、医生、病人和门诊病人。方法邀请俄亥俄州东北部执业家庭医生参与一项关于初级保健实习内容的多方法研究。研究护士直接观察连续的患者就诊情况，并使用医疗记录回顾、患者和医生问卷调查、账单数据、执业环境清单和人种学现场记录收集额外数据。结果共观察84家诊所138名医生、4454名患者就诊情况。家庭医生的门诊就诊包括各种各样的病人、问题和复杂程度。在过去的一年中，患者平均去了4.3次诊所。平均访问时间为10分钟。58%的病人是急性病，24%是慢性病，12%是健康护理。最常见的时间用途是记录病史、计划治疗、体检、健康教育、反馈、家庭信息、聊天、组织互动和患者问题。结论：家庭实践和患者访问是复杂的，有竞争的需求和机会来解决个人和家庭的各种问题，随着时间的推移和在不同的健康和疾病阶段。实践环境中的多方法研究可以确定增强家庭实践竞争机会的方法，以改善患者的健康。
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.