1 Institute for Health, Health Care Policy, and Aging Research and Department of Economics, Rutgers University, New Brunswick, New Jersey, USA 2 Institute for Health, Health Care Policy, and Aging Research and Department of Sociology, Rutgers University, New Brunswick, New Jersey, USA.
Patient. 2008 Jul 1;1(3):211-22. doi: 10.2165/1312067-200801030-00008.
In Crossing the Quality Chasm, the Institute of Medicine recommended that patient-centered care should not waste patients' time and should recognize the involvement of family and friends. Studies have documented the time spent by physicians on outpatient visits, but not that spent by patients and their companions. The patient's perspective provides an important yet overlooked indicator of healthcare effectiveness.
To document how much time American patients spend on outpatient visits, for what purposes (travel, waiting, receiving services), and the time required of family members and friends.
We used data from the first 4 years (2003-6) of the American Time Use Survey (ATUS), conducted by the US Census Bureau for the Bureau of Labor Statistics, which asks respondents about their activities over a 24-hour period. ATUS is a nationally representative population-based survey that samples days continuously throughout the year. In 2003-6, 60 674 respondents aged ≥15 years were randomly selected from households that completed the Current Population Survey; 1621 reported seeking medical care for themselves on their survey day. We documented the percentage of the population that reported outpatient visits, the percentage who were accompanied to those visits and by whom, and the mean time spent by patients and their companions, by type of activity, and by age and sex.
After weighting the data to represent the US population, we found that 3.4% of people aged ≥15 years reported traveling, waiting, or receiving services in connection with an outpatient visit on their survey day. The mean time for those who reported the activity was 35 minutes for travel (95% CI 33, 37), 42 minutes of waiting (95% CI 37, 47), and 74 minutes receiving services (95% CI 70, 79). Overall, 39.5% were accompanied, usually by family members. Companions spent a mean of 124 minutes per encounter (95% CI 112, 135). Nearly half of those aged ≥65 years were accompanied, almost always by adults only, suggesting that they may have needed help with transportation, negotiating the healthcare system, or performing cognitive and emotional tasks involved in receiving care.
Outpatient visits are time intensive for American patients and their families: the equivalent of 207 million 40-hour work-weeks each year. Patients and their families spend substantially more time on outpatient visits than the time with the physician reported by the annual National Ambulatory Medical Care Survey. Further research is needed on the components of outpatient visits that do not directly involve physicians. Efforts to improve care should address waiting times and recognize the involvement of family members. The ATUS could provide periodic benchmarks of patient time use as a supplement to other indicators of patient-centered care in the annual National Healthcare Quality Report.
在《跨越质量鸿沟》中，美国医学研究所建议以患者为中心的护理不应该浪费患者的时间，并应该认识到家庭成员和朋友的参与。已经有研究记录了医生在门诊就诊时花费的时间，但没有记录患者及其同伴花费的时间。患者的视角提供了一个重要但被忽视的医疗效果指标。
记录美国患者在门诊就诊时花费的时间，以及他们的就诊目的（旅行、等待、接受服务），以及家庭成员和朋友所需的时间。
我们使用了美国人口普查局为劳工统计局进行的美国时间使用调查（ATUS）的前 4 年（2003-6 年）的数据，该调查要求受访者在 24 小时内报告他们的活动。ATUS 是一项基于全国代表性人口的调查，全年连续抽样。在 2003-6 年期间，从完成当前人口调查的家庭中随机选择了 60674 名年龄≥15 岁的受访者；其中 1621 名受访者在调查日报告了自己的医疗就诊。我们记录了报告门诊就诊的人口百分比、陪同就诊的人数及其身份，以及患者及其同伴按活动类型、年龄和性别划分的平均就诊时间。
对数据进行加权以代表美国人口后，我们发现 3.4%的年龄≥15 岁的人在调查日报告了与门诊就诊相关的旅行、等待或接受服务。报告该活动的人的平均时间为旅行 35 分钟（95%CI 33, 37），等待 42 分钟（95%CI 37, 47），接受服务 74 分钟（95%CI 70, 79）。总体而言，39.5%的人有陪同，通常是家庭成员。同伴每次就诊平均花费 124 分钟（95%CI 112, 135）。近一半的≥65 岁的人有陪同，几乎都是成年人，这表明他们可能需要帮助进行交通、与医疗保健系统协商，或完成接受护理涉及的认知和情感任务。
美国患者及其家属的门诊就诊时间非常紧张：每年相当于 2.07 亿个 40 小时的工作周。患者及其家属在门诊就诊上花费的时间远远超过了年度国家门诊医疗保健调查中报告的与医生在一起的时间。需要进一步研究门诊就诊中不直接涉及医生的部分。改善护理的努力应该解决等待时间，并认识到家庭成员的参与。ATUS 可以定期提供患者时间使用的基准，作为年度国家医疗保健质量报告中患者为中心护理的其他指标的补充。
