Skip to main content

Main menu

  • Home
  • Current Issue
  • Content
    • Current Issue
    • Early Access
    • Multimedia
    • Podcast
    • Collections
    • Past Issues
    • Articles by Subject
    • Articles by Type
    • Supplements
    • Plain Language Summaries
    • Calls for Papers
  • Info for
    • Authors
    • Reviewers
    • Job Seekers
    • Media
  • About
    • Annals of Family Medicine
    • Editorial Staff & Boards
    • Sponsoring Organizations
    • Copyrights & Permissions
    • Announcements
  • Engage
    • Engage
    • e-Letters (Comments)
    • Subscribe
    • Podcast
    • E-mail Alerts
    • Journal Club
    • RSS
    • Annals Forum (Archive)
  • Contact
    • Contact Us
  • Careers

User menu

  • My alerts

Search

  • Advanced search
Annals of Family Medicine
  • My alerts
Annals of Family Medicine

Advanced Search

  • Home
  • Current Issue
  • Content
    • Current Issue
    • Early Access
    • Multimedia
    • Podcast
    • Collections
    • Past Issues
    • Articles by Subject
    • Articles by Type
    • Supplements
    • Plain Language Summaries
    • Calls for Papers
  • Info for
    • Authors
    • Reviewers
    • Job Seekers
    • Media
  • About
    • Annals of Family Medicine
    • Editorial Staff & Boards
    • Sponsoring Organizations
    • Copyrights & Permissions
    • Announcements
  • Engage
    • Engage
    • e-Letters (Comments)
    • Subscribe
    • Podcast
    • E-mail Alerts
    • Journal Club
    • RSS
    • Annals Forum (Archive)
  • Contact
    • Contact Us
  • Careers
  • Follow annalsfm on Twitter
  • Visit annalsfm on Facebook
Research ArticleMethodology

A Method for Estimating Relative Complexity of Ambulatory Care

David A. Katerndahl, Robert Wood and Carlos Roberto Jaén
The Annals of Family Medicine July 2010, 8 (4) 341-347; DOI: https://doi.org/10.1370/afm.1157
David A. Katerndahl
MD, MA
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Robert Wood
DrPH
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Carlos Roberto Jaén
MD, PhD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • eLetters
  • Info & Metrics
  • PDF
Loading

Article Figures & Data

Figures

  • Tables
  • Additional Files
  • Figure 1.
    • Download figure
    • Open in new tab
    • Download powerpoint
    Figure 1.

    Variance as function of sample.

Tables

  • Figures
  • Additional Files
    • View popup
    Table 1.

    Complexity of Family Medicine Based on 2000 NAMCS Data

    CategoryComplexity Mean (95% CI)
    NAMCS = National Ambulatory Medical Care Survey.
    Note: Number of visits = 3,344, weighted number of visits = 198,577,765
    Input
        Reasons for visit0.7653229 (0.7653068–0.7653390)
        Diagnoses0.7961640 (0.7961385–0.7961896)
        Examination/testing0.8304157 (0.8303451–0.8304860)
        Patient characteristics1.9661301 (1.9661250–1.9661354)
        Total input4.3580328 (4.3579610–4.358105)
    Output
        Medications1.0313165 (1.0312906–1.0313423)
        Procedures0.0185481 (0.0185459–0.0185504)
        Other therapies0.3721766 (0.3719765–0.3723768)
        Patient disposition0.7257469 (0.7257469–0.72575)
        Total output2.1477881 (2.1475856–2.1479906)
    Total encounter44.0443 (44.039722–44.048957)
    • View popup
    Table 2.

    Validation of Complexity Estimates Based on Relative Complexity of Family Medicine, Cardiology, and Psychiatry

    MeasureFamily Medicine (n=3443,344)Cardiology (n=1,650)Psychiatry (n=1,567)
    Note: Based on 2000 National Ambulatory Medical Care Survey database; n = number of visits.
    Input
    Estimated complexity4.364.103.12
        7±2 complexity, %3.83.80.0
        Proportion acute problems, %24.94.93.6
        Uncertain diagnosis, %2.21.20.9
    Output
    Estimated complexity2.152.492.02
        7±2 complexity, %<1.0<1.0<1.0
    • View popup
    Table 3.

    Adjusting Estimated Complexity for Duration-of-Visit

    MeasureFamily Medicine (Weighted Visits=98,577,765) Mean (95% CI)Cardiology (Weighted Visits=21,598,184) Mean (95% CI)Psychiatry (Weighted Visits=28,864,201) Mean (95% CI)
    CI=confidence interval.
    Note: Based on 2000 National Ambulatory Medical Care Survey database.
    Estimated total complexity44.044339 (44.039722–44.048957)42.779207 (42.771360–42.787053)17.492836 (17.489900–17.495771)
    Duration-of-visit, min15.793105 (15.792874–15.793336)20.468510 (20.46820–20.46882)33.633497 (33.632895–33.634100)
    Complexity per minute2.7888336 (2.7885402–2.7891270)2.090001 (2.089619–2.090383)0.5201017 (0.5200140–0.5201893)
    Complexity per hour167.33002 (167.31242–167.34762)125.40008 (125.37717–125.42300)31.206097 (31.200836–31.211358)

Additional Files

  • Figures
  • Tables
  • Supplemental Appendix

    Supplemental Appendix. Computation of Complexity Computation

    Files in this Data Supplement:

    • Supplemental data: Appendix - PDF file, 3 pages
  • The Article in Brief

    A Method for Estimating Relative Complexity of Ambulatory Care

    David A. Katerndahl , and colleagues

    Background Primary care physicians have long been fighting for a system of compensation that recognizes the complexity of the primary care visit. The current system does not account for several important aspects of primary care, including interactions between multiple "agents" (patient, family, friends, physician, office staff) and the patient's multiple, less-defined illnesses; less-specific diagnostic tests; and variable patient behavior. This article demonstrates a method for calculating the relative complexity of office visits in the primary care setting. The method estimates complexity based on the amount of care provided weighted by its diversity and variability.

    What This Study Found Analyzing data from the 2000 National Ambulatory Medical Care Survey using this method, researchers found that when adjusted for duration of visit, family medicine has a greater complexity density per hour (167) than either cardiology (125) or psychiatry (31).

    Implications

    • The complexity of medical care has important implications for health policy.
PreviousNext
Back to top

In this issue

The Annals of Family Medicine: 8 (4)
The Annals of Family Medicine: 8 (4)
Vol. 8, Issue 4
1 Jul 2010
  • Table of Contents
  • Index by author
  • In Brief
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on Annals of Family Medicine.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
A Method for Estimating Relative Complexity of Ambulatory Care
(Your Name) has sent you a message from Annals of Family Medicine
(Your Name) thought you would like to see the Annals of Family Medicine web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
1 + 17 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.
Citation Tools
A Method for Estimating Relative Complexity of Ambulatory Care
David A. Katerndahl, Robert Wood, Carlos Roberto Jaén
The Annals of Family Medicine Jul 2010, 8 (4) 341-347; DOI: 10.1370/afm.1157

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Get Permissions
Share
A Method for Estimating Relative Complexity of Ambulatory Care
David A. Katerndahl, Robert Wood, Carlos Roberto Jaén
The Annals of Family Medicine Jul 2010, 8 (4) 341-347; DOI: 10.1370/afm.1157
Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Abstract
    • INTRODUCTION
    • EVIDENCE OF COMPLEXITY IN PRIMARY CARE
    • ESTIMATING COMPLEXITY
    • CURRENT ESTIMATES OF COMPLEXITY
    • METHOD FOR ESTIMATING THE COMPLEXITY OF AMBULATORY CARE
    • CRITIQUE OF ESTIMATION METHOD
    • COMPLEXITY DENSITY
    • POTENTIAL APPLICATIONS
    • Footnotes
    • REFERENCES
  • Figures & Data
  • eLetters
  • Info & Metrics
  • PDF

Related Articles

  • PubMed
  • Google Scholar

Cited By...

  • General practice -- the integrating discipline
  • Measuring the complexity of general practice consultations: a Delphi and cross-sectional study in English primary care
  • Capturing complexity in clinician case-mix: classification system development using GP and physician associate data
  • Decisional needs assessment of patients with complex care needs in primary care: a participatory systematic mixed studies review protocol
  • The Challenges of Measuring, Improving, and Reporting Quality in Primary Care
  • Panel Workload Assessment in US Primary Care: Accounting for Non-Face-to-Face Panel Management Activities
  • Systems and Complexity Thinking in the General Practice Literature: An Integrative, Historical Narrative Review
  • Family Medicine Outpatient Encounters are More Complex Than Those of Cardiology and Psychiatry
  • Health Care Reform and Equity: Promise, Pitfalls, and Prescriptions
  • Are measures of patient satisfaction hopelessly flawed?
  • The Heart of Family Medicine
  • Ethics, Support for Care, Prevention, and What's Important
  • Google Scholar

More in this TOC Section

  • Joint Display of Integrated Data Collection for Mixed Methods Research: An Illustration From a Pediatric Oncology Quality Improvement Study
  • Patient-Guided Tours: A Patient-Centered Methodology to Understand Patient Experiences of Health Care
  • Putting Evidence Into Practice: An Update on the US Preventive Services Task Force Methods for Developing Recommendations for Preventive Services
Show more Methodology

Similar Articles

Subjects

  • Methods:
    • Quantitative methods
  • Other research types:
    • Health policy
    • Health services
    • Professional practice

Content

  • Current Issue
  • Past Issues
  • Early Access
  • Plain-Language Summaries
  • Multimedia
  • Podcast
  • Articles by Type
  • Articles by Subject
  • Supplements
  • Calls for Papers

Info for

  • Authors
  • Reviewers
  • Job Seekers
  • Media

Engage

  • E-mail Alerts
  • e-Letters (Comments)
  • RSS
  • Journal Club
  • Submit a Manuscript
  • Subscribe
  • Family Medicine Careers

About

  • About Us
  • Editorial Board & Staff
  • Sponsoring Organizations
  • Copyrights & Permissions
  • Contact Us
  • eLetter/Comments Policy

© 2025 Annals of Family Medicine