Flocke S A, Frank S H, Wenger D A
Department of Family Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
J Fam Pract. 2001 Mar;50(3):211-6.
The purpose of the study was to describe the number of problems addressed during family practice outpatient visits, the nature of additional problems raised, how they affect the duration of the visit, and how well they are reflected in the billing record.
Cross-sectional.
We studied a total 266 randomly selected adult patient encounters representing 37 physicians.
A problem was defined as an issue requiring physician action in the form of a decision, diagnosis, treatment, or monitoring. Visit duration and the number of billing diagnoses were also assessed.
On average, 2.7 problems and 8 physician actions were observed during an encounter. More than one problem was addressed during 73% of the encounters; 36% of these additional problems were raised by the physician and 58% by the patient. On average, each additional problem increased the length of the visit by 2.5 minutes (P<.001). The concordance between the number of problems observed and the number of problems on the billing sheet indicated a trend toward underbilling the number of problems addressed.
Multiple problems are commonly addressed during family practice outpatient visits and are raised by both the physicians and the patients. Our findings suggest that current views of physician productivity and the billing record are poor indicators of the reality of providing primary care.
本研究旨在描述家庭医疗门诊就诊期间所处理问题的数量、提出的其他问题的性质、这些问题如何影响就诊时长以及它们在计费记录中的反映情况。
横断面研究。
我们共研究了随机选取的代表37位医生的266例成年患者就诊情况。
问题被定义为需要医生以决策、诊断、治疗或监测等形式采取行动的事项。还评估了就诊时长和计费诊断数量。
每次就诊平均观察到2.7个问题和8项医生行动。73%的就诊处理了不止一个问题；其中36%的其他问题由医生提出，58%由患者提出。平均而言，每个额外问题使就诊时长增加2.5分钟（P<0.001）。观察到的问题数量与计费单上的问题数量之间的一致性表明存在对所处理问题数量计费不足的趋势。
家庭医疗门诊就诊期间通常会处理多个问题，且医生和患者都会提出这些问题。我们的研究结果表明，目前对医生工作效率和计费记录的看法并不能很好地反映提供初级医疗服务的实际情况。
