TY - JOUR
KW - Ambulatory Care/statistics & numerical data
KW - Chronic Disease/therapy
KW - Cross-Sectional Studies
KW - Humans
KW - Interdisciplinary Communication
KW - Medicine/organization & administration
KW - Outcome and Process Assessment (Health Care)/statistics & numerical data
KW - Patient Care Team/organization & administration
KW - Patient-Centered Care/organization & administration
KW - Physicians, Primary Care/organization & administration
KW - Primary Health Care/manpower/organization & administration
KW - Quality of Health Care/organization & administration
KW - Referral and Consultation/organization & administration/statistics & numerical data
KW - Time Factors
AU - J. M. Hollingsworth
AU - S. Saint
AU - R. A. Hayward
AU - M. A. Rogers
AU - L. Zhang
AU - D. C. Miller
A1 - 
AB - BACKGROUND: The medical home's success depends, in part, on the degree to which primary care physicians (PCPs) and specialists collaborate to create "medical neighborhoods" based on collective accountability. Such collaboration may require a new equilibrium in chronic disease care, with some of the routine follow-up currently provided by specialists reallocated to PCPs and their medical home teams. OBJECTIVES: To measure the care delivered by specialists for 7 chronic conditions, and to estimate the implications associated with reallocating half among the PCP workforce. RESEARCH DESIGN: Cross-sectional. SUBJECTS: Physicians from the 2007 National Ambulatory Medical Care Survey. MEASURES: We identified adult ambulatory visits for chronic obstructive pulmonary disease/asthma, low back pain, diabetes mellitus, coronary artery disease/congestive heart failure, chronic kidney disease, and depression. We calculated the time spent by specialists in direct and indirect care for established patients with these conditions. We summed individual physician estimates across specialists and converted the total into annual work weeks. After reducing this figure by half, we divided by the number of active PCPs. RESULTS: Most specialty visits (76.8%; 95% confidence interval [CI]: 73.6%-79.7%) were made by established patients. Specialists spent 552,844 (95% CI: 454,660-651,029) and 108,113 (95% CI: 86,103-130,122) cumulative work weeks providing direct and indirect follow-up care, respectively. Reallocating half of this care would generate 3.2 (95% CI: 2.6-3.8) additional work weeks for each PCP. CONCLUSIONS: The cumulative time spent by specialists in routine chronic disease follow-up is nontrivial. Reallocation of this care to PCP-directed medical homes may require multidimensional efforts to expand the primary care workforce.
BT - Medical care
C5 - Medical Home
CP - 1
CY - United States
DO - 10.1097/MLR.0b013e3181f537b0
IS - 1
JF - Medical care
N2 - BACKGROUND: The medical home's success depends, in part, on the degree to which primary care physicians (PCPs) and specialists collaborate to create "medical neighborhoods" based on collective accountability. Such collaboration may require a new equilibrium in chronic disease care, with some of the routine follow-up currently provided by specialists reallocated to PCPs and their medical home teams. OBJECTIVES: To measure the care delivered by specialists for 7 chronic conditions, and to estimate the implications associated with reallocating half among the PCP workforce. RESEARCH DESIGN: Cross-sectional. SUBJECTS: Physicians from the 2007 National Ambulatory Medical Care Survey. MEASURES: We identified adult ambulatory visits for chronic obstructive pulmonary disease/asthma, low back pain, diabetes mellitus, coronary artery disease/congestive heart failure, chronic kidney disease, and depression. We calculated the time spent by specialists in direct and indirect care for established patients with these conditions. We summed individual physician estimates across specialists and converted the total into annual work weeks. After reducing this figure by half, we divided by the number of active PCPs. RESULTS: Most specialty visits (76.8%; 95% confidence interval [CI]: 73.6%-79.7%) were made by established patients. Specialists spent 552,844 (95% CI: 454,660-651,029) and 108,113 (95% CI: 86,103-130,122) cumulative work weeks providing direct and indirect follow-up care, respectively. Reallocating half of this care would generate 3.2 (95% CI: 2.6-3.8) additional work weeks for each PCP. CONCLUSIONS: The cumulative time spent by specialists in routine chronic disease follow-up is nontrivial. Reallocation of this care to PCP-directed medical homes may require multidimensional efforts to expand the primary care workforce.
PP - United States
PY - 2011
SN - 1537-1948; 0025-7079
SP - 4
EP - 9
EP - 
T1 - Specialty care and the patient-centered medical home
T2 - Medical care
TI - Specialty care and the patient-centered medical home
U1 - Medical Home
U2 - 20966777
U3 - 10.1097/MLR.0b013e3181f537b0
VL - 49
VO - 1537-1948; 0025-7079
Y1 - 2011
ER -