Measuring the range of services clinicians are responsible for in ambulatory practice

Semel, Marcus E.; Bader, Angela M.; Marston, Amy; Lipsitz, Stuart R.; Marshall, Richard; Gawande, Atul A.

doi:10.1111/j.1365-2753.2010.01598.x

Cited by 9 publications

(8 citation statements)

References 7 publications

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“…The case-mix mean of 23 different types of surgery in our study is consistent with findings from a recent study showing that surgeons manage a wide variety of primary diagnoses, with 136 to 236 different primary diagnoses per full time equivalent (FTE) 21 . The average surgeon in our study devoted less than 30% of their practice to their most common procedure, and their second most common procedure was often unrelated.…”

Section: Discussionsupporting

confidence: 89%

“…Our study shows that many general surgeons still have broad and heterogeneous practices. This conclusion is also supported by findings from previous studies which demonstrated that general surgeons perform a broad variety of procedures that span the sub-specialties 3 , the clinical classification system 20 , and various ICD-9 diagnoses 21 . These results have significant implications for surgical education in an era of increasing healthcare specialization.…”

Section: Discussionsupporting

confidence: 82%

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Specialization and the Current Practices of General Surgeons

Decker

Dodgion

Kwok

et al. 2014

Journal of the American College of Surgeons

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Background The impact of specialization on the practice of general surgery has not been characterized. Our goal was to assess general surgeons’ operative practices to inform surgical education and workforce planning. Study Design We examined the practices of general surgeons identified in the 2008 State Inpatient and Ambulatory Surgery Databases of the Healthcare Cost and Utilization Project (HCUP) for three US states. Operations were identified using ICD-9 and CPT codes linked to encrypted physician identifiers. For each surgeon, total operative volume and the percentage of practice comprised of their most common operation were calculated. Correlation was measured between general surgeons’ case volume and the number of other specialists in a health service area. Results There were 1,075 general surgeons who performed 240,510 operations in 2008. The mean operative volume for each surgeon was 224 annual procedures. General surgeons performed an average of 23 different types of operations. For the majority of general surgeons, their most common procedure comprised no more than 30% of total practice. The most common operations, ranked by the frequency that they appeared as general surgeons’ top procedure, included: cholecystectomy, colonoscopy, endoscopy, and skin excision. The proportion of general surgery practice comprised of endoscopic procedures inversely correlated with the number of gastroenterologists in the health service area (Rho = - 0.50, p = 0.005). Conclusions Despite trends toward specialization, the current practices of general surgeons remain heterogeneous. This indicates a continued demand for broad-based surgical education to allow future surgeons to tailor their practices to their environment.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 82%

Specialization and the Current Practices of General Surgeons

Decker

Dodgion

Kwok

et al. 2014

Journal of the American College of Surgeons

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“…Although there is repetition in outpatient medical care, the 25 most common diagnoses account for only 40% of all primary diagnoses, suggesting significant variety and substantial primary care provider management of complex diagnoses and medications. 9 In addition to the complexity of health care described above, recent work also suggests that ambiguity is another factor to take into account when considering implementation of interventions in health care. Ambiguity is defined as "uncertainty or vagueness that may prevent the system from achieving its purpose."…”

Section: Healthcare System Complexity and Ambiguitymentioning

confidence: 99%

Translating Evidence into Practice Using a Systems Engineering Framework for Infection Prevention

Yanke

Carayon

Safdar

2014

Infect. Control Hosp. Epidemiol.

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The current infection prevention era is defined by the rise of healthcare-associated infections (HAIs) and multidrug-resistant organisms (MDROs). Efforts to combat these and other emerging pathogens have resulted in rapid and ongoing evolution of the contemporary infection prevention environment. Currently, HAIs impose a significant burden on the US healthcare system. Recent analysis of National Healthcare Safety Network data from the early 2000s suggests that at least 1.7 million HAIs occur yearly in US hospitals, associated with at least 99,000 deaths. These numbers have likely increased over the past decade and suggest that HAIs are among the leading causes of death in the United States.

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“…We conducted a nested case-control study using administrative data from HVMA, a large nonprofit multispecialty group practice in New England providing care to 325,000 patients with >3 million ambulatory visits on an annual basis. 7 HVMA has an integrated electronic medical record system with comprehensive capture of longitudinal data on sociodemographics, diagnostic and procedural codes, laboratory results, prescription dispensation, ambulatory encounters, and vital status, and has been employed in numerous health services and epidemiologic research studies. 8 Patients were included provided that they were age ≥18 years old and met the following criteria: i.…”

Section: Study Cohortmentioning

confidence: 99%

Iodinated contrast media exposure and incident hyperthyroidism and hypothyroidism in a community-based cohort

et al. 2013

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Recent data suggest iodinated contrast media (ICM) exposure is associated with increased risk of incident hyperthyroidism among patients receiving care from two tertiary care medical centers. We sought to confirm and generalize these findings by conducting a casecontrol study among a broadly-representative community-based cohort of patients receiving care within Harvard Vanguard Medical Associates from 1996 to 2012. Incident hyperthyroid and hypothyroid cases were defined by change in thyrotropin (TSH) from normal (at baseline), to low or high (at follow-up), respectively. In parallel analyses, hyper-and hypothyroid cases were matched to euthyroid controls using incidence density sampling, and ICM exposure was ascertained using claims data. Secondary analyses examined associations with incident overt hyperthyroidism and overt hypothyroidism (follow-up TSH≤0.1 mIU/L and TSH>10 mIU/L, respectively). We observed that ICM exposure was associated with increased risk of incident hyperthyroidism [odds ratio, 1.61 (95% CI) 1.27-2.04], incident overt hyperthyroidism [odds ratio, 1.62 (95% CI) 1.08-2.43], and incident overt hypothyroidism [odds ratio 2.01 (95% CI) 1. 25-3.23]. These data confirm that ICM exposure is associated with increased risk of incident thyroid functional disease in a community-based cohort of patients in an iodine-sufficient region.

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Measuring the range of services clinicians are responsible for in ambulatory practice

Abstract: Physicians routinely manage a substantial variety of diagnoses, medications, and other tests and procedures. Quality improvement and health services researchers have generally focused on individual services but also must consider the wide variety and range of services delivered.

Cited by 9 publications

References 7 publications

Specialization and the Current Practices of General Surgeons

Specialization and the Current Practices of General Surgeons

Translating Evidence into Practice Using a Systems Engineering Framework for Infection Prevention

Iodinated contrast media exposure and incident hyperthyroidism and hypothyroidism in a community-based cohort

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