A Comparison of the National Ambulatory Medical Care Survey (NAMCS) Measurement Approach With Direct Observation of Outpatient Visits

Gilchrist, Valerie; Stange, Kurt C.; Flocke, Susan A.; McCord, Gary; Bourguet, Claire C.

doi:10.1097/01.mlr.0000114916.95639.af

Cited by 158 publications

(130 citation statements)

References 32 publications

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“…The other 3 visit lengths were underreported by providers by 4 to 6 minutes. These findings are consistent with reported recall bias 24 that needs to be considered when using provider recall of visit length in research. Underreporting of visit length might have contributed to the general feeling of not having enough time to spend with patients.…”

Section: Visit Reconstruction By Providerssupporting

confidence: 81%

A Case Study of Early Experience with Implementation of Collaborative Care in the Veterans Health Administration

Tai–Seale

Kunik

Shepherd³

et al. 2010

Population Health Management

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Primary care remains critically important for those who suffer from mental disorders. Although collaborative care, which integrates mental health services into primary care, has been shown to be more effective than usual care, its implementation has been slow and the experience of providers and patients with collaborative care is less well known. The objective of this case study was to examine the effects of collaborative care on patient and primary care provider (PCP) experiences and communication during clinical encounters.Participating physicians completed a self-administered visit reconstruction questionnaire in which they logged details of patient visits and described their perceptions of the visits and the influence of collaborative care. Audio recordings of visits were analyzed to assess the extent of discussion about colocated mental health services and visit time devoted to mental health topics.The main outcome measures were the extent of discussion and recommendation for collaborative care during clinical visits and providers' experiences based on their responses to the visit reconstruction questionnaire. Providers surveyed expressed enthusiasm about collaborative care and cited the time constraint of office visits and lack of specialty support as the main reasons for limiting their discussion of mental health topics with patients.

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Section: Visit Reconstruction By Providerssupporting

confidence: 81%

A Case Study of Early Experience with Implementation of Collaborative Care in the Veterans Health Administration

Tai–Seale

Kunik

Shepherd³

et al. 2010

Population Health Management

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“…The National Center for Health Statistics provides complete descriptions of both surveys and yearly data at http://www.cdc.gov/nchs/about/major/ahcd/ahcd1.htm. These surveys, particularly NAMCS, have been validated against other data sources 30 and have also been used in past research of antihypertensive prescribing. 19 In brief, NAMCS captures healthcare services provided by officebased physicians, whereas NHAMCS assesses services offered at hospital outpatient departments.…”

Section: Data Sourcesmentioning

confidence: 99%

Changes in Antihypertensive Prescribing During US Outpatient Visits for Uncomplicated Hypertension Between 1993 and 2004

Lee

Stafford

2006

Hypertension

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Abstract-Monitoring national patterns of antihypertensive drug therapy is essential to assessing adherence to treatment guidelines and the impact of major scientific publications on physician prescribing. We analyzed data from 2 US National Ambulatory Care Surveys to examine trends between 1993 and 2004 in the prescription of antihypertensive drug classes for uncomplicated hypertension and the association between thiazide and ␤-blocker prescribing and physician and patient characteristics. 1998 -2004 (versus 1993-1997). Blacks, women, and hospital outpatients were more likely to receive thiazides. Also, cardiologists were more likely to prescribe ␤-blockers. Evidence-based guidelines for antihypertensive drug therapy do impact physician prescribing, but the impact seems to be short lived. Future interventions are imperative for promoting long-term adherence to published guidelines.

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“…The DES form was closely modeled after forms of the National Ambulatory Medical Care Survey (NAMCS), 22,23 which have been found to generate data with high concordance to direct observation of physician behavior. Furthermore, the survey was reviewed by the DBPNet site principal investigator at each participating site for relevance, clarity, and face validity.…”

Section: Methodsmentioning

confidence: 99%

“…22 Unlike surveys S85 by guest on May 10, 2018 http://pediatrics.aappublications.org/ Downloaded from that ask physicians to summarize their clinical practices or to estimate the proportion of time they use to complete various procedures or recommend various treatments, the method used in NAMCS and this study required physicians to complete a detailed questionnaire on unselected consecutive cases in whom the diagnosis of ASD was made. This method has been found to generate data with high concordance to direct observation of physician behavior.…”

Section: Figurementioning

confidence: 99%

“…This method has been found to generate data with high concordance to direct observation of physician behavior. 22 The number of respondents, although modest, represents ∼10% of all board-certified developmentalbehavioral pediatricians who are active in clinical practice. All of the respondents were affiliated with academic medical centers, in divisions of DBP.…”

Section: Figurementioning

confidence: 99%

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Diagnosis of Autism Spectrum Disorder by Developmental-Behavioral Pediatricians in Academic Centers: A DBPNet Study

et al. 2016

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on behalf of the DBPNet Steering Committee abstract OBJECTIVES: To describe the clinical practices of physicians in the Developmental-Behavioral Pediatrics Network (DBPNet) to (1) diagnose autism spectrum disorders (ASDs), identify comorbidities, and evaluate etiology and (2) compare actual practice to established guidelines. METHODS:A total of 56 developmental-behavioral pediatricians completed encounter forms, including demographic/clinical information, for up to 10 consecutive new-patient visits given a diagnosis of ASD. Data were summarized by using descriptive statistics. Analysis of the statistical significance of differences between sites (n = 10) used general estimating equations and mixed-effects logistic regression to adjust for clustering by clinician within site. RESULTS:A total of 284 ASD forms were submitted. Most assessments (56%) were completed in 1 visit (27.5% in 2 visits, 8.6% in 3 visits). Use of the Childhood Autism Rating Scale, Autism Diagnostic Observation Schedule, or Screening Tool for Autism in Toddlers and Young Children varied across sites from 28.6% to 100% of encounters (P < .001). A developmental assessment was reviewed/completed at 87.7% of encounters (range: 77.8%-100%; P = .061), parent behavior rating scales were reviewed/completed at 65.9% (range: 35.7%-91.4%; P = .19), and teacher behavior rating scales were reviewed/completed at 38.4% (range: 15%-69.2%; P = .19). Only 17.3% (95% confidence interval: 12.8%-21.7%) of evaluations were completed by an interdisciplinary team. A majority (71%) of patients had at least 1 comorbid diagnosis (31% had at least 2 and 12% at had least 3). Etiologic evaluations were primarily genetic (karyotype: 49%; microarray: 69.7%; fragile X: 71.5%).CONCLUSIONS: Despite site variability, the majority of diagnostic evaluations for ASD within DBPNet were completed by developmental-behavioral pediatricians without an interdisciplinary team and included a developmental assessment, ASD-specific assessment tools, and parent behavior rating scales. These findings document the multiple components of assessment used by DBPNet physicians and where they align with existing guidelines. The importance of early identification and treatment of optimal outcomes is also becoming increasingly clear, 4-6 yet difficulties with access to specialty care, long clinic waiting lists, and other barriers to early diagnosis and treatment exist in most parts of the United States. [7][8][9][10] Varying recommendations for diagnostic assessment of ASD in clinical practice have been proposed 7,[11][12][13][14][15][16] that include the use of interdisciplinary assessments as well as standardized assessments using researchvalidated instruments such as the Autism Diagnostic Observation Scheduless (ADOS) and the Autism Diagnostic Interview-Revised (ADI-R). In addition, recommendations for etiologic assessments in ASD continue to change with advances in clinical research and accessibility to genetic technology. [17][18][19][20] Several guidelines have been published by the American Aca...

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A Comparison of the National Ambulatory Medical Care Survey (NAMCS) Measurement Approach With Direct Observation of Outpatient Visits

Cited by 158 publications

References 32 publications

A Case Study of Early Experience with Implementation of Collaborative Care in the Veterans Health Administration

A Case Study of Early Experience with Implementation of Collaborative Care in the Veterans Health Administration

Changes in Antihypertensive Prescribing During US Outpatient Visits for Uncomplicated Hypertension Between 1993 and 2004

Diagnosis of Autism Spectrum Disorder by Developmental-Behavioral Pediatricians in Academic Centers: A DBPNet Study

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