Physician extenders in walk-in clinics: a prospective evaluation of the AMOSIST program

The Automated Military Outpatient System (AMOS) Project was developed to improve the ambulatory care of patients with episodic and chronic illnesses. During the development of its episodic care component, the relative frequency of problems treated by the walk-in clinic staff was analyzed and showed a high volume of acute minor illnesses. A simple, conservative triage system run by non-professionals was developed to screen patients to a clinic for benign, self-limited illnesses run by physician-extenders. This group, the equivalent of civilian licensed practical nurses and nurses' aides, was trained in a task-oriented fashion to treat 44 common minor illnesses. Clinical algorithms for these illnesses were developed and used as training tools, memory aids, and auditing instruments. This program is now operating in 26 US Army hospitals and caring for some 44,000 patients a month in the continetal United States. We report the results of a prospective audit of the corpsmen and a study of the patient attitude and acceptance of the program.