title: Family medicine outpatient encounters are more complex than those of cardiology and psychiatry.
abstract: BACKGROUND
  comparison studies suggest that the guideline-concordant care provided for specific medical conditions is less optimal in primary care compared with cardiology and psychiatry settings. The purpose of this study is to estimate the relative complexity of patient encounters in general/family practice, cardiology, and psychiatry settings.
  
  
  METHODS
  secondary analysis of the 2000 National Ambulatory Medical Care Survey data for ambulatory patients seen in general/family practice, cardiology, and psychiatry settings was performed. The complexity for each variable was estimated as the quantity weighted by variability and diversity.
  
  
  RESULTS
  there is minimal difference in the unadjusted input and total encounter complexity of general/family practice and cardiology; psychiatry's input is less complex. Cardiology encounters involved more input quantitatively, but the diversity of general/family practice input eliminated the difference. Cardiology also involved more complex output. However, when the duration of visit is factored in, the complexity of care provided per hour in general/family practice is 33% more relative to cardiology and 5 times more relative to psychiatry.
  
  
  CONCLUSIONS
  care during family physician visits is more complex per hour than the care during visits to cardiologists or psychiatrists. This may account for a lower rate of completion of process items measured for quality of care.
authors.affiliation: Departments of Family and Community Medicine, University of Texas Health Science Center, San Antonio, TX 78229-3900, USA. katerndahl@uthscsa.edu
authors.forename: David
authors.initials: D
authors.lastname: Katerndahl
authors.forename: Robert
authors.initials: R
authors.lastname: Wood
authors.forename: Carlos Roberto
authors.initials: CR
authors.lastname: Jaén
mesh_terms: D000553:Ambulatory Care / Q000379:methods* / Q000706:statistics & numerical data; D002309:Cardiology / Q000379:methods* / Q000706:statistics & numerical data; D016001:Confidence Intervals; D016208:Databases, Factual / Q000706:statistics & numerical data; D005194:Family Practice / Q000379:methods* / Q000706:statistics & numerical data; D019538:Health Care Surveys; D006801:Humans; D008511:Medicine / Q000379:methods / Q000706:statistics & numerical data; D017711:Nonlinear Dynamics; D010045:Outpatients; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011570:Psychiatry / Q000379:methods* / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000706:statistics & numerical data; D012017:Referral and Consultation; D013598:Systems Theory; D014481:United States