title: Rethinking primary care visits: how much can be eliminated, delegated or performed outside of the face-to-face visit?
abstract: OBJECTIVE
  Office visits represent the core component of primary care practice, but little is known about what percentage of primary care provider (PCP) visit time could be suitable for reassignment to another medical home team member or to a non-face-to-face modality (e.g. secure messaging) in order to optimize face-to-face PCP visit time.
  
  
  METHODS
  We videotaped 121 PCP office visits at four Veterans Health Administration Medical Centers and divided visits into discrete activity segments. Two physicians reviewed each visit recording and provided independent clinical judgments regarding which segments might be suitable for reassignment. We examined the activity category distribution of visit time rated as needing face-to-face time with a PCP.
  
  
  RESULTS
  Reviewers judged 53% of the 5398 minutes of rated visit time as suitable for reassignment to another team member or modality. The percentage of time rated as needing face-to-face PCP care varied greatly by activity category, from a high of 73.9% (for examining patients) to a low of 16.2% (for medication review). Rater agreement regarding tasks' suitability for reassignment varied across activity categories.
  
  
  CONCLUSIONS
  These data offer an example of how face-to-face PCP visit time might be optimized as practices seek to shift components of patient care to other team members and other modalities. Given variations in provider preferences and judgments, successful redesign efforts will need to involve stakeholders in decisions about how to best utilize medical home resources.
authors.affiliation: Center for Evaluation of Patient Aligned Care Teams (CEPACT), Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA.
authors.forename: Mary
authors.initials: M
authors.lastname: Pelak
authors.affiliation: Boston, MA, USA.
authors.forename: Amy R
authors.initials: AR
authors.lastname: Pettit
authors.affiliation: Center for Evaluation of Patient Aligned Care Teams (CEPACT), Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA.|The Wharton School and Professor of Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Christian
authors.initials: C
authors.lastname: Terwiesch
authors.affiliation: Center for Evaluation of Patient Aligned Care Teams (CEPACT), Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA.
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Gutierrez
authors.affiliation: Center for Evaluation of Patient Aligned Care Teams (CEPACT), Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA.|University of Pennsylvania School of Social Policy and Practice, Philadelphia, PA, USA.
authors.forename: Steven C
authors.initials: SC
authors.lastname: Marcus
mesh_terms: D006302:Health Services Research; D006787:Hospitals, Veterans; D006801:Humans; D009819:Office Visits; D018802:Patient-Centered Care / Q000458:organization & administration*; D011216:Practice Management, Medical / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration*; D011787:Quality of Health Care; D014481:United States; D014743:Videotape Recording
keywords: face-to-face visits; patient-centred medical home; practice revision; primary care; routine practice; videotaping