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At least 19 recordsLinked to original sources
PubMed1990

The functional status of patients. How can it be measured in physicians' offices?

Physicians wishing to maintain the functional capacity of their patients often need, but usually do not have, practical measures of function. The Dartmouth COOP, a primary care research network, developed nine pictorial Charts to efficiently measure patient function in busy office practice. Each Chart has a five-point scale, is illustrated, and can be self-administered or administered by office staff. The Charts are used to measure the patients' overall functional health just as Snellen Charts are used to measure vision. Studies to assess the Charts' reliability, validity, acceptability and clinical utility were conducted on over 2,000 patients in four diverse clinical settings. Results show that the Charts are both reliable and valid. One-hour test-retest intraclass correlations for elderly patients ranged from 0.78 to 0.98 and from 0.73 to 0.98 for low income patients. The average Pearson product-moment correlation between Charts and previously validated measures of function was 0.61 and the Charts were as capable of detecting the association between disease and functioning as were longer, standard measures. Most clinicians and patients report that the Charts are easy to use and provide a valuable tool to measure overall function in busy office practice. For the 25% of patients in which the Charts uncovered new information, changes in clinical management were initiated for 40% of them. We conclude that the COOP Charts are practical, reliable, valid, sensitive to the effects of disease and useful for quickly measuring patient function.

Activities of Daily Living↗
PubMed1994

The 12 deadly sins committed by physician office laboratories.

Physician office laboratories are being inspected for compliance with the Clinical Laboratory Improvement Act of 1988 (CLIA-88). If a physician office laboratory addresses and corrects these 12 mistakes, it will be more efficient and have a head start toward CLIA compliance.

Laboratories↗
PubMed1997

Negotiating a sound physician office lease.

Physician group practices that lease office space should consider several issues before signing a lease. These issues include whether to hire a broker to assist in the search for office space, negotiating lease provisions that pertain to compliance with the Americans with Disabilities Act; confidentiality of patient records; proper disposal of medical waste and other hazardous materials; compliance with occupational safety standards; quiet enjoyment; and utility use. In addition, physician group practices that lease office space from other healthcare providers must ensure that the lease terms conform with antifraud and abuse safe harbor regulations.

Air Conditioning↗
PubMed1994

A role for case managers in the physician office.

Independent primary care physicians continue to be important gatekeepers for health care services needed by older patients. There is a natural role for case management in the physician office as a link to nonmedical support services that can help the elderly maintain their independence. In this article, the authors describe a model partnership between primary care physicians and a community-wide case management program that was developed to enhance the continuum of care and improve integration of service systems. Rapid response for assessments, brief interventions, and linkage to home and community services are provided through a case manager/liaison who is on-call to physician offices. Patients are seen in the physician office or in their homes or contacted by telephone. The liaison assesses and provides immediate information and referral, maintains short-term contact, or refers patients with complex situations or long-term case management needs to agency or community case management programs. The liaison also makes regular office rounds to maintain visibility, discuss cases, and educate staff about patient risk factors. Physicians and patients have been pleased with the model.

Aged↗
PubMed2002

Putting outcomes into practice in physician offices.

Implementing outcomes in physician offices is a challenging area. Unlike hospitals, clinics typically have much fewer support staff and resources, electronic clinical data is difficult to access, and physician resistance may be significant. Yet, accountability for outcomes is coming to physician offices. In all outcome efforts, the key steps for guideline implementation are awareness, agreement, decision to adopt, and commitment to adherence. This article describes outcome management efforts in a 15-clinic medical group in the areas of diabetes, asthma, preventive health, pneumonia, heart failure, and patient satisfaction. Implementation strategies, barriers, impact, and outcome data results are described.

Adult↗
PubMed1997

Ambulatory care visits of physician offices, hospital outpatient departments, and emergency departments: United States, 1995.

OBJECTIVES: This report describes ambulatory care visits in the United States across three ambulatory care settings-physician offices, hospital outpatient departments, and hospital emergency departments. Statistics are presented on selected patient and visit characteristics for aggregated ambulatory care visits and for each setting. METHODS: The data presented in this report were collected by means of the 1995 National Ambulatory Medical Care Survey (NAMCS) and the 1995 National Hospital Ambulatory Medical Care Survey (NHAMCS). These surveys are part of the ambulatory care component of the National Health Care Survey that measures health care utilization across a variety of providers. The NAMCS and NHAMCS are national probability sample surveys of visits to office-based physicians (NAMCS) and visits to the outpatient departments and emergency departments of non-Federal, short-stay and general hospitals (NHAMCS) in the United States. Sample data are weighted to produce annual estimates. RESULTS: During 1995 an estimated 860.9 million visits were made to physician offices, hospital outpatient departments, and hospital emergency departments in the United States, an overall rate of 3.3 visits per person. Visits to office-based physicians accounted for 81.0 percent of ambulatory care utilization, followed by visits to emergency departments (11.2 percent) and outpatient departments (7.8 percent). Persons 75 years and over had the highest rate of ambulatory care visits. Females had significantly higher rates of visits to physician offices and hospital outpatient departments than males did. Less than two-thirds of ambulatory care visits by black persons were to physician offices. There were an estimated 126.1 million injury-related ambulatory care visits during 1995, or 48.2 visits per 100 persons.

Adolescent↗
PubMed1990

Physicians' office laboratories.

The number of physicians' office laboratories (POLs) is increasing. Formal technical education and certification for physician office laboratory personnel assure more accurate results.

Hazardous Substances↗
PubMed1999

Ambulatory care visits to physician offices, hospital outpatient departments, and emergency departments: United States, 1997.

OBJECTIVE: This report describes ambulatory care visits in the United States across three ambulatory care settings--physician offices, hospital outpatient departments, and hospital emergency departments. Statistics are presented on selected patient and visit characteristics for all ambulatory care visits and separately for each setting. METHODS: The data presented in this report are from the 1997 National Ambulatory Medical Care Survey (NAMCS) and the 1997 National Hospital Ambulatory Medical Care Survey (NHAMCS). These surveys are part of the ambulatory care component of the National Health Care Survey that measures health care utilization across a variety of health care providers. NAMCS and NHAMCS are national probability sample surveys of visits to office-based physicians (NAMCS) and visits to the outpatient departments and emergency departments of non-Federal, short-stay and general hospitals (NHAMCS) in the United States. Sample data are weighted to produce annual estimates. RESULTS: During 1997, an estimated 959.3 million visits were made to physician offices, hospital outpatient departments, and hospital emergency departments in the United States, an overall rate of 3.6 visits per person. Visits to office-based physicians accounted for 82.1 percent of ambulatory care utilization, followed by visits to emergency departments (9.9 percent) and outpatient departments (8.0 percent). Utilization varied by patient age, sex, and race. Persons 75 years and over had the highest rate of ambulatory care visits. Females had significantly higher rates of visits to physician offices and hospital outpatient departments than males did. White persons utilized physician offices at a higher rate compared with black persons. There were an estimated 123.8 million injury-related ambulatory care visits during 1997, or 46.4 visits per 100 persons.

Adolescent↗
PubMed1998

Ambulatory care visits to physician offices, hospital outpatient departments, and emergency departments: United States, 1996.

OBJECTIVE: This report describes ambulatory care visits in the United States across three ambulatory care settings--physician offices, hospital outpatient departments, and hospital emergency departments. Statistics are presented on selected patient and visit characteristics for all ambulatory care visits and separately for each setting. METHODS: The data presented in this report were collected by means of the 1996 National Ambulatory Medical Care Survey (NAMCS) and the 1996 National Hospital Ambulatory Medical Care Survey (NHAMCS). These surveys are part of the ambulatory care component of the National Health Care Survey that measures health care utilization across a variety of providers. The NAMCS and NHAMCS are national probability sample surveys of visits to office-based physicians (NAMCS) and visits to the outpatient departments and emergency departments of non-Federal, short-stay and general hospitals (NHAMCS) in the United States. Sample data are weighted to produce annual estimates. RESULTS: During 1996 an estimated 892 million visits were made to physician offices, hospital outpatient departments, and hospital emergency departments in the United States, an overall rate of 3.4 visits per person. Visits to office-based physicians accounted for 82.3 percent of ambulatory care utilization, followed by visits to emergency departments (10.1 percent) and outpatient departments (7.5 percent). Persons 75 years and over had the highest rate of ambulatory care visits. Females had significantly higher rates of visits to physician offices and hospital outpatient departments than males did. About two-thirds of ambulatory care visits by black persons were to physician offices. There were an estimated 129.3 million injury-related ambulatory care visits during 1996 or 48.9 visits per 100 persons.

Adolescent↗
PubMed2005

Recruitment of physician offices for an office-based adolescent smoking cessation study.

Physician office settings play an important role in tobacco cessation intervention. However, few tobacco cessation trials are conducted at these sites, in part because of the many challenges associated with recruiting community physician offices into research. The present study identified and implemented strategies for recruiting physician offices into a randomized clinical trial of tobacco screening and cessation interventions with adolescent patients. A total of 30 community physicians participated in focus groups to elicit their perceptions of facilitators of and barriers to initial engagement of physician practices and the subsequent enrollment of the practices in long-term research projects. Physicians identified facilitators such as (a) the involvement of office staff in the recruitment process and (b) on-site presentations of the study's background and aims. Some of the barriers identified were time commitment concerns and the lack of incentives in exchange for participation. These focus group findings were then integrated with theory-based and empirically driven recruitment strategies for a 12-month randomized tobacco intervention trial with adolescent patients. Of 185 office practices approached to participate (screened from a pool of 273 practices), 103 agreed to on-site presentations of the study. Subsequently, almost all of the practices (101) that received the presentation agreed to enroll in the study. Conclusions are that (a) recruitment is a multicomponent process, (b) the processes of communication, engagement, and enrollment must be carefully planned and implemented to achieve maximal results, and (c) the development of effective strategies for recruiting health care provider practices presents an important infrastructure for testing adolescent smoking cessation interventions.

Adolescent↗
PubMedDate not supplied

Providing pharmaceutical care in a physician office.

OBJECTIVE: To develop a physician office-based pharmaceutical care practice and evaluate the impact on the participating physicians, their staff, and patients. SETTING: Internal medicine physician office. PRACTICE DESCRIPTION: Two physicians and two nurses practice in a medical office complex in a rural setting in eastern Washington. PRACTICE INNOVATION: Development of an experimental pharmaceutical care program in which a registered pharmacist works in a physician office to evaluate the medication needs of patients and to provide pharmaceutical care and medication information to health professionals and patients. MAIN OUTCOME MEASURES: Functions and interventions performed by the pharmacist; types of disease states in patients that were confronted by the pharmacist; summary of time spent with patients; and attitudes of physicians and patients concerning the pharmacist interventions. RESULTS: 660 pharmacist interventions or functions occurred during the seven months of the project. Of 107 recommendations to the physicians concerning changes in therapy, 89 were accepted. Patients suffered from 53 different disease states that were evaluated by the pharmacist. The pharmacist spent from less than 5 minutes to more than an hour with individual patients, 5 to 15 minutes with the majority of patients. Both patients and physicians were impressed with the service and strongly desired to have it continued. CONCLUSION: There is a career opportunity for pharmacists to provide pharmaceutical care in the setting of a physician office practice. Many of the barriers to providing pharmaceutical care can be eliminated or diminished in this setting.

Humans↗
PubMed1996

Impact of CLIA on physician office laboratories in rural Washington State.

BACKGROUND: Despite physician concerns to the contrary, the United States Health Care Financing Administration (HCFA) estimated that its regulations implementing the Clinical Laboratory Improvements Act of 1988 (CLIA) would cause few physician office laboratories to either close or reduce testing. METHODS: A survey requesting information about tests performed before and after the implementation of CLIA was developed and mailed to all members of the rural practice section of the Washington Academy of Family Physicians. RESULTS: There were significant changes in the complexity of laboratory tests performed before and after implementation of CLIA. Among independent family physicians' office laboratories, waived-status laboratories (i.e., those performing only the simplest and lowest risk tests) increased from 1% to 34%, laboratories performing tests of moderate complexity declined from 76% to 53%, and laboratories performing high-complexity tests declined from 23% to 13%. The shift to waived status was more pronounced among solo and small group physicians in smaller communities. CONCLUSIONS: HCFA seriously underestimated the impact of CLIA on rural physician office laboratories.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed2004

Ambulatory care visits to physician offices, hospital outpatient departments, and emergency departments: United States, 1999--2000.

OBJECTIVE: This report describes ambulatory care visits to physician offices, hospital outpatient departments (OPDs), and hospital emergency departments (EDs) as well as factors that may affect where care is sought. Ambulatory medical care utilization is described in terms of patient, practice/facility, and visit characteristics. Visits to office-based physicians are divided into the categories of primary care, surgical specialties, and medical specialties. METHODS: Data from the 1999 and 2000 National Ambulatory Medical Care Surveys (NAMCS) and National Hospital Ambulatory Medical Care Surveys (NHAMCS) were combined to produce averaged annual estimates of ambulatory medical care utilization. To examine changes over time, current data were compared with data from the 1993 and 1994 NAMCS and NHAMCS. RESULTS: Patients in the United States made an estimated 979 million visits per year in 1999 and 2000 to physician offices, hospital OPDs, and EDs, an annual rate of 3.6 visits per person. The distribution of visits by patient age, sex, race, expected source of payment, geographic region, and metropolitan statistical area (MSA) status varied across settings. The percentage of visits to office-based primary care physicians was similar for the characteristics studied, but the percentage of visits to office-based surgical and medical specialists varied considerably. Black persons had higher visit rates than white persons to hospital OPDs and EDs but lower rates to office-based surgical and medical specialists. ED visits were more likely to be patient-paid or no charge than were visits to office-based physicians. Visit rates to office-based medical specialists decreased between 1993--94 and 1999--2000. Visit rates increased for hypertension and diabetes diagnoses, as did prescription rates for central nervous system, hormonal, pain relief, and respiratory tract drugs.

Adolescent↗
PubMed2000

Workshop to implement the baby-friendly office initiative. Effect on community physicians' offices.

OBJECTIVE: To assess the effect of a self-appraisal questionnaire and a workshop for office staff in promoting the baby-friendly office (BFO). DESIGN: A two-times-three factorial design with a delayed workshop for one of two groups: an early intervention group who attended a workshop for office staff in October 1997 (n = 23) and a late-intervention group who attended in April 1998 (n = 23). Self-appraisals were completed before the workshops by all participants in October 1997, by 37 offices in April 1998, and by 34 offices in October 1998. SETTING: Offices of family physicians and primary care pediatricians in Hamilton-Wentworth, Ont. PARTICIPANTS: Staff of 46 offices; 74% (34/46) completed all three assessments. MAIN OUTCOME MEASURES: Degree of change in implementing each of the "10 Steps to Baby-Friendly Office" and overall average BFO score received by each office. RESULTS: Of the 34 offices completing all assessments, none followed all 10 steps. Initial mean score was 4.4 steps (standard deviation 1.4, n = 46). The workshop intervention improved overall mean scores from 4.3 to 5.6 (P < .001, n = 37). Although office staff completed the BFO self-appraisal tool, it alone had no effect on scores. Areas of improvement were noted in providing information to patients and displaying posters to promote breastfeeding. Key steps, such as not advertising breast milk substitutes and not distributing free formula, did not change. CONCLUSION: The workshop effected a modest but positive change in breastfeeding promotion. The change was maintained at 6 and 12 months after the intervention.

Adult↗
PubMed1991

Physician office laboratory regulations.

Physicians must not ignore the OSHA standards. All physicians should meet the requirements now and then they will feel confident that they have provided their employees with a safe working environment.

Laboratories↗
PubMed1991

Physician office laboratory quality assurance.

The physician office laboratory (POL) must establish a quality assurance (QA) program. QA is the process of assuring that all testing services have been performed. Documentation of an office QA protocol is a requirement of the upcoming federal regulations (CLIA-88).

Humans↗