TY - JOUR
T1 - A method for estimating relative complexity of ambulatory care
AU - Katerndahl, David A.
AU - Wood, Robert
AU - Jaén, Carlos Roberto
PY - 2010
Y1 - 2010
N2 - PURPOSE: We wanted to demonstrate a method for calculating the relative complexity of ambulatory clinical encounters.&METHODS: Measures of complexity should ref ect 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 def ned 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.&RESULTS: Using the 2000 NAMCS database, we calculated input and output complexities for 3 specialties. Construct validity was aff rmed 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).&CONCLUSIONS: This 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.
AB - PURPOSE: We wanted to demonstrate a method for calculating the relative complexity of ambulatory clinical encounters.&METHODS: Measures of complexity should ref ect 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 def ned 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.&RESULTS: Using the 2000 NAMCS database, we calculated input and output complexities for 3 specialties. Construct validity was aff rmed 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).&CONCLUSIONS: This 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.
KW - Ambulatory care
KW - Nonlinear dynamics
KW - Process assessment (health care)
KW - Systems theory
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U2 - 10.1370/afm.1157
DO - 10.1370/afm.1157
M3 - Article
C2 - 20644189
AN - SCOPUS:77955137663
SN - 1544-1709
VL - 8
SP - 341
EP - 347
JO - Annals of family medicine
JF - Annals of family medicine
IS - 4
ER -