Article Figures & Data
Figures
- Figure 1.
Variance as function of sample.
Tables
Category Complexity 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 visit 0.7653229 (0.7653068–0.7653390) Diagnoses 0.7961640 (0.7961385–0.7961896) Examination/testing 0.8304157 (0.8303451–0.8304860) Patient characteristics 1.9661301 (1.9661250–1.9661354) Total input 4.3580328 (4.3579610–4.358105) Output Medications 1.0313165 (1.0312906–1.0313423) Procedures 0.0185481 (0.0185459–0.0185504) Other therapies 0.3721766 (0.3719765–0.3723768) Patient disposition 0.7257469 (0.7257469–0.72575) Total output 2.1477881 (2.1475856–2.1479906) Total encounter 44.0443 (44.039722–44.048957) - Table 2.
Validation of Complexity Estimates Based on Relative Complexity of Family Medicine, Cardiology, and Psychiatry
Measure Family 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 complexity 4.36 4.10 3.12 7±2 complexity, % 3.8 3.8 0.0 Proportion acute problems, % 24.9 4.9 3.6 Uncertain diagnosis, % 2.2 1.2 0.9 Output Estimated complexity 2.15 2.49 2.02 7±2 complexity, % <1.0 <1.0 <1.0 Measure Family 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 complexity 44.044339 (44.039722–44.048957) 42.779207 (42.771360–42.787053) 17.492836 (17.489900–17.495771) Duration-of-visit, min 15.793105 (15.792874–15.793336) 20.468510 (20.46820–20.46882) 33.633497 (33.632895–33.634100) Complexity per minute 2.7888336 (2.7885402–2.7891270) 2.090001 (2.089619–2.090383) 0.5201017 (0.5200140–0.5201893) Complexity per hour 167.33002 (167.31242–167.34762) 125.40008 (125.37717–125.42300) 31.206097 (31.200836–31.211358)
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.
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