title: How many problems do family physicians manage at each encounter? A WReN study.
abstract: OBJECTIVE
  The number of problems managed concurrently by family physicians during patient encounters has not been fully explored despite the implications for quality assessment, guideline implementation, education, research, administration, and funding. Our study objective was to determine the number of problems physicians report managing at each visit and compare that with the number reflected in the chart and the bill.
  
  
  METHODS
  Twenty-nine members of the Wisconsin Research Network reported on encounters with 572 patients using a physician problem log. The patient chart notes and the diagnoses submitted for billing from the encounters were compared with the information in these logs.
  
  
  RESULTS
  The physicians reported managing an average of 3.05 problems per encounter and recorded 2.82 in the chart and 1.97 on the bill. For all patients, 37% of encounters addressed more than 3 problems, and 18% addressed more than 4. For patients older than 65 years, there was an average of 3.88 problems at each visit, and for diabetic patients there was an average of 4.60. There was evidence for the selective omission of mental health and substance problems from the diagnoses used for billing.
  
  
  CONCLUSIONS
  Family medicine involves the concurrent care of multiple problems, which billing data do not adequately reflect. Our findings suggest a mismatch between family medicine and current approaches to quality assessment, guideline implementation, education, research, administration, and funding. Activities in all these areas need to address the physician's task of prioritizing and integrating care for multiple problems concurrently.
authors.affiliation: Department of Family Medicine, University of Wisconsin Medical School, Madison, Wis 53715, USA. jbeasley@fammed.wisc.edu
authors.forename: John W
authors.initials: JW
authors.lastname: Beasley
authors.forename: Terry H
authors.initials: TH
authors.lastname: Hankey
authors.forename: Rodney
authors.initials: R
authors.lastname: Erickson
authors.forename: Kurt C
authors.initials: KC
authors.lastname: Stange
authors.forename: Marlon
authors.initials: M
authors.lastname: Mundt
authors.forename: Marguerite
authors.initials: M
authors.lastname: Elliott
authors.forename: Pamela
authors.initials: P
authors.lastname: Wiesen
authors.forename: James
authors.initials: J
authors.lastname: Bobula
mesh_terms: D000367:Age Factors; D000368:Aged; D005194:Family Practice; D005251:Fees, Medical; D005260:Female; D005568:Forms and Records Control; D006801:Humans; D008297:Male; D008499:Medical Records; D009819:Office Visits / Q000191:economics / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians'; D014922:Wisconsin