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How many problems do family physicians manage at each encounter? A WReN study
John W Beasley1, Terry H Hankey, Rodney Erickson
1Department of Family Medicine, University of Wisconsin Medical School, Madison, Wis 53715, USA. jbeasley@fammed.wisc.edu
Annals of Family Medicine
|October 28, 2004
Summary
Family physicians manage an average of 3.05 problems per visit, but billing records often reflect fewer. This discrepancy impacts healthcare quality assessment and funding for family medicine.
Area of Science:
- Family Medicine
- Healthcare Management
- Clinical Informatics
Background:
- The complexity of concurrent problem management in family medicine is under-researched.
- Accurate problem counts are crucial for quality assessment, guideline implementation, education, research, administration, and funding.
Purpose of the Study:
- To quantify the number of problems managed by family physicians per encounter.
- To compare physician-reported problems with those documented in charts and billing records.
Main Methods:
- Utilized a physician problem log from 29 Wisconsin Research Network members.
- Collected data on 572 patient encounters.
- Compared physician logs with patient chart notes and billing diagnoses.
Main Results:
- Physicians reported managing an average of 3.05 problems per encounter, compared to 2.82 in charts and 1.97 in billing.
- 37% of encounters involved more than 3 problems, and 18% involved more than 4.
- Older patients (65+) averaged 3.88 problems, and diabetic patients averaged 4.60 problems per visit.
Conclusions:
- Family medicine inherently involves managing multiple concurrent problems.
- Current billing data inadequately represent the scope of care provided.
- A significant mismatch exists between clinical practice and administrative/funding structures, necessitating adjustments in quality assessment and resource allocation.