Departments of Family and Community Medicine, University of Texas Health Science Center, San Antonio, TX 78229-3900, USA.
J Am Board Fam Med. 2011 Jan-Feb;24(1):6-15. doi: 10.3122/jabfm.2011.01.100057.
comparison studies suggest that the guideline-concordant care provided for specific medical conditions is less optimal in primary care compared with cardiology and psychiatry settings. The purpose of this study is to estimate the relative complexity of patient encounters in general/family practice, cardiology, and psychiatry settings.
secondary analysis of the 2000 National Ambulatory Medical Care Survey data for ambulatory patients seen in general/family practice, cardiology, and psychiatry settings was performed. The complexity for each variable was estimated as the quantity weighted by variability and diversity.
there is minimal difference in the unadjusted input and total encounter complexity of general/family practice and cardiology; psychiatry's input is less complex. Cardiology encounters involved more input quantitatively, but the diversity of general/family practice input eliminated the difference. Cardiology also involved more complex output. However, when the duration of visit is factored in, the complexity of care provided per hour in general/family practice is 33% more relative to cardiology and 5 times more relative to psychiatry.
care during family physician visits is more complex per hour than the care during visits to cardiologists or psychiatrists. This may account for a lower rate of completion of process items measured for quality of care.
对比研究表明，与心脏病学和精神病学环境相比，初级保健中针对特定医疗条件的循证护理并不理想。本研究的目的是评估普通/家庭实践、心脏病学和精神病学环境中患者就诊的相对复杂性。
对普通/家庭实践、心脏病学和精神病学环境中接受门诊治疗的患者 2000 年全国门诊医疗调查数据进行二次分析。对每个变量的复杂性进行了估计，即数量乘以变异性和多样性的权重。
普通/家庭实践和心脏病学的未经调整的输入和总就诊复杂性差异极小；精神病学的输入较为简单。心脏病学就诊的输入在数量上更多，但普通/家庭实践输入的多样性消除了差异。心脏病学就诊还涉及更复杂的输出。然而，当考虑就诊时间时，普通/家庭实践就诊每小时提供的护理复杂性相对心脏病学就诊要高出 33%，相对精神病学就诊要高出 5 倍。
家庭医生就诊时每小时的护理比心脏病专家或精神科医生就诊时的护理更为复杂。这可能是衡量护理质量的过程项目完成率较低的原因之一。
