title: Patient care outside of office visits: a primary care physician time study.
abstract: BACKGROUND
  Patient care provided by primary care physicians outside of office visits is important for care coordination and may serve as a substitute for office visits.
  
  
  OBJECTIVE
  To describe primary care physicians' ambulatory patient care activities outside of office visits ("AOVs") and their perceptions of the extent to which AOVs substitute for visits and may be performed by support staff.
  
  
  METHODS
  Cross-sectional direct observational study.
  
  
  METHODS
  Thirty-three general internists in 20 practices in two health care systems (one public, one private) in the New York metropolitan area.
  
  
  METHODS
  Duration of AOVs by type of activity and whether they pertain to a patient visit on the study day (visit specific) or not (non-visit specific). Physician perceptions of the: (1) extent that non-visit-specific AOVs substitute for visits that would have otherwise occurred, (2) extent that visits that occurred could have been substituted for by AOVs, and (3) potential role of support staff in AOVs.
  
  
  RESULTS
  Physicians spent 20% of their workday performing AOVs, 62% of which was for non-visit specific AOVs. They perceived that a median of 37% of non-visit-specific AOV time substituted for visits, representing a potential five visits saved per day. They also perceived that 15% of total AOV time (excluding charting) could be performed by support staff. Forty-two percent of physicians indicated that one or more visits during the study day could be substituted for by AOVs.
  
  
  CONCLUSIONS
  Though time spent on AOVs is generally not reimbursed, primary care general internists spent significant time performing AOVs, much of which they perceived to substitute for visits that would otherwise have occurred. Policies supporting physician and staff time spent on AOVs may reduce health care costs, save time for patients and physicians, and improve care coordination.
authors.affiliation: Division of Clinical Epidemiology and Evaluative Sciences Research, Department of Medicine, Weill Cornell Medical College, 1300 York Avenue, Box 46, New York, NY 10065, USA. mec2015@med.cornell.edu
authors.forename: Melinda A
authors.initials: MA
authors.lastname: Chen
authors.forename: James P
authors.initials: JP
authors.lastname: Hollenberg
authors.forename: Walid
authors.initials: W
authors.lastname: Michelen
authors.forename: Janey C
authors.initials: JC
authors.lastname: Peterson
authors.forename: Lawrence P
authors.initials: LP
authors.lastname: Casalino
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000379:methods; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009819:Office Visits; D005791:Patient Care / Q000379:methods; D058007:Physicians, Primary Care / Q000458:organization & administration* / Q000523:psychology; D010865:Pilot Projects; D011795:Surveys and Questionnaires; D017748:Time Management / Q000379:methods / Q000458:organization & administration*; D013996:Time and Motion Studies
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