Method Estimates Complexity of Ambulatory Encounters

In another study, nurse-led approach with older patients linked to doctor-perceived benefits
By Eric Metcalf
HealthDay Reporter

WEDNESDAY, July 21 (HealthDay News) -- A method of estimating the relative complexity of ambulatory clinical encounters could be useful in making comparisons between specialties, and the Guided Care approach may provide benefits for primary care physicians who work with chronically ill older patients, according to two studies published in the July/August Annals of Family Medicine.

David A. Katerndahl, M.D., of the University of Texas Health Science Center at San Antonio, and colleagues calculated input and output complexities for three specialties -- family medicine, cardiology, and psychiatry -- using National Ambulatory Medical Care Survey data. Inputs include factors like history and physical exams, and outputs include medications prescribed, counseling, and procedures. The total relative complexity was similar for cardiology and family medicine, but after adjustment for duration of visit, family medicine had a higher complexity density per hour than the other specialties.

Jill A. Marsteller, Ph.D., of the Johns Hopkins Bloomberg School of Public Health in Baltimore, and colleagues analyzed data from 49 physicians and their chronically ill older patients. Fourteen teams of physicians provided either usual care or Guided Care, which involved a specially educated registered nurse who provided eight processes such as home assessment and monthly monitoring for 50 to 60 patients. Physicians in the Guided Care group reported higher satisfaction with patient/family communication and knowledge of the clinical characteristics of their patients compared to the physicians in the control group.

"Although the Guided Care nurse learns more about the patient than the physician might otherwise know, how much of that additional information is shared with the physician depends on the teamwork between the nurse and physician and the number and efficiency of their meetings or other communications (such as e-mails and in-person discussions); these specifics could not feasibly be measured. The physicians, however, would never have less information under Guided Care than under usual care, because they maintain regular appointments with the patients," Marsteller and colleagues conclude.

Abstract - Katerndahl
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Abstract - Marsteller
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