ArticleAnnals of family medicine
A method for estimating relative complexity of ambulatory care.
Article in Annals of family medicine. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 1 of them a synthesis that pooled it.
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Who cites it
23 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Decision-making and related outcomes of patients with complex care needs in primary care settings: a systematic literature review with a case-based qualitative synthesis.BMC primary care · 2022Pooled it
- Family Physicians' Views of Who They Are Accountable To and Current Quality Metrics.JAMA network open · 2026Article
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- General practice - the integrating discipline.The British journal of general practice : the journal of the Royal College of General Practitioners · 2023Article
- It's about time: redesigning consultation length in general practice.Journal of the Royal Society of Medicine · 2022Article
- I am ready to see you now, Doctor! A mixed-method study of the Let's Discuss Health website implementation in Primary Care.Health expectations : an international journal of public participation in health care and health policy · 2021Article
- Towards Continuing Interprofessional Education: Interaction patterns of health professionals in a resource-limited setting.PloS one · 2021Article
- The Relationships Between Patient Experience and Quality and Utilization of Primary Care Services.Journal of patient experience · 2020Article
- Differences in the Complexity of Office Visits by Physician Specialty: NAMCS 2013-2016.Journal of general internal medicine · 2020Article
- Burnout Among Physicians, Advanced Practice Clinicians and Staff in Smaller Primary Care Practices.Journal of general internal medicine · 2018Article
- Capturing complexity in clinician case-mix: classification system development using GP and physician associate data.BJGP open · 2018Article
- Diagnostic protocols-A consultation tool still to be discovered.Journal of evaluation in clinical practice · 2018Observational
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- Identifying complexity in infectious diseases inpatient settings: An observation study.Journal of biomedical informatics · 2017Article
- Management of Hypertension in Primary Care Safety-Net Clinics in the United States: A Comparison of Community Health Centers and Private Physicians' Offices.Health services research · 2017Article
- The Challenges of Measuring, Improving, and Reporting Quality in Primary Care.Annals of family medicine · 2017Article
- Investing in Relationships and Teams to Support Managing Complexity.Journal of general internal medicine · 2017Article
- Understanding complex clinical reasoning in infectious diseases for improving clinical decision support design.BMC medical informatics and decision making · 2015Article
- Describing the content of primary care: limitations of Canadian billing data.BMC family practice · 2012Article
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Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeWe wanted to demonstrate a method for calculating the relative complexity of ambulatory clinical encounters.
methodsMeasures of complexity should reflect the complexity of the typical encounter and across encounters. If inputs represent the information transferred from the patient to the physician, then inputs include history, physical examination, testing, diagnoses, and patient demographics. Outputs include medications prescribed and other therapies used, including education and counseling, procedures performed, and disposition. The complexity of each input/output is defined as the mean input/output quantity per clinical encounter weighted by its inter-encounter diversity (range of possibilities used) and variability (visit-to-visit change). In complex systems, as the information in the input increases linearly, the complexity of the system increases exponentially. To assess the impact of the complexity of the encounter on the physician, we adjusted the estimated complexity by the duration-of-visit.
resultsUsing the 2000 NAMCS database, we calculated input and output complexities for 3 specialties. Construct validity was affirmed by comparing the relative rankings of complexity against relative rankings using other complexity-related measures. Although total relative complexity was similar for family medicine (44.04 +/- 0.0024 SE) and cardiology (42.78 +/- 0.0004 standard error [SE]), when adjusted for duration-of-visit, family medicine had a greater complexity density per hour (167.33 +/- 0.0095 SE) than either cardiology (125.4 +/- 0.0117 SE) or psychiatry (31.21 +/- 0.0027 SE).
conclusionsThis method estimates complexity based on the amount of care provided weighted by its diversity and variability. Such estimates could have broad use for interphysician comparisons as well as longitudinal applications.
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