Data from the

NATIONAL HEALTH SURVEY

AmbulatoryCare Utilization Patterns

of Childrenand YoungAdults:

NationalAmbulatory MedicalCare Survey

UnitedStates, January- December 1975

Using data obtained from a national probability sample of officebased physicians, statistics are presented on the utilization of

ambulatory care by children and young adults under 22 years of

age. Ambulatory care visits are described in terms of demographic

utilization patterns and in terms of physician utilization patterns.

Also shown are distributions of office visits according to the patient’s prior-visit status, the patient’s problem or complaint, seriousness ‘of the problem, physician’s diagnosis, diagnostic and therapeutic services ordered or provided, disposition, and duration of

visit.

DHEW Publication No. (PHS) 78-1790

Series 13

Number 39

U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE

Public Health Service

National Center for Health Statistics

Hyattsville, Md. August 1978
—

,

,/ /

Library of Congress Cataloging in Publication Data

Ezz+iti,Trcna hl.

Ambulatory care utilization patterns of children and youn~ adults.

(Vital and health statistics: Series 13, Data from the National Health Sur\ey; no. 39)

(DHEW publication; no. (PHS) 78-1 790)

Includes bibliographical references.

1. Ambulatory medical care for children–United States–Utilizatio~ ~-Statistics. 2. Physician serwces utilization-United State s—fjtatistics. 3. Children–Diseases-–United States–

Statistics. 4. Health sur\-eys–United States. 5. United States–Statistics, Yledical. I. United

States. National Center for Health Statistics. II. Title. III. Series: united States. National

Center for Health Statistics. Vital and health statistics: Series 13, Data from the National

Health Suney, Data on health resources utilization; no. 39. IV. Series: United States. Dept.

of Health, Education, and 1$’elfare. DHEW publication; no. (PHS) 78-1790. [D.NLM: 1. Ambulatory care–In infant> and childhood-Statistics. 2. .4mbulatory care —In adolescence–

Statistics. 3. Health services–Utilization--U.S. 4. Utili~ation review. 14’2 A N 148vm no.

39 (P)]

RA407.3.A349 no. 39 [RJ102] 362.1 ”1’0973s [362.7’8’1]

ISBN 0-8406 -0134-4 78-606086
NATIONAL CENTER FOR HEALTH STATISTICS

DOROTHY P. RICE, Director

ROBERT A. ISMEL, Deputy Director

JACOB J. FELDMAN, Ph.D., Associate Director for Analysis

GAIL F. FISHER, Ph.D., Associate Director for the Cooperative Health Statistics System

ELIJAH L. WHITE, Associate Director for Data Systems

JAMES T. BAIRD, JR., Ph.D., Associate Director for International Statistics

ROBERT C. HUBER, Associate Director for Management

MONROE G. SIRKEN, Ph.D., Associate Director for Mathematical Statistics

PETER L. HURLEY, Associate Director for Operations

JAMES M. ROBEY, Ph.D., Associate Director for Program Development

PAUL E. LEAVERTON, Ph.D., Associate Director for Research

ALICE HAYWOOD, Information Officer

DIVISION OF HEALTH RESOURCES UTILIZATION STATISTICS

SIEGFRIED A. HOE RMANN, Director

JOAN F. VAN NOSTRAND, Chief Long-Temn Care Statistics Branch

W. EDWARD BACON, Ph.D., Chief Hospital Care Statistics Branch

STEWART C. RICE, Chief Family Pknning Statistics Branch

JAMES E. DeLOZIER, Chiej Ambzdato~ Care Statistics Branch

MANOOCHEHR K. NOZARY, Chief Technical Seruices Branch

Vital and Health Statistics-Series 13-No. 39

DHEW Publication No. (PHS) 78-1790

Library of Congress Catalog Card Number 78-606086
CONTENTS

Introduction .............................................................................................................................................. I

Scope of the Survey .............................................................................................................................. 1

Source and Limitations of Data............................................................................................................ 1

Demographic Utilization Patterns .............................................................................................................. 2

Physician Utilization Patterns.................................................................................................................... 3

Utilization by Visit Characteristics ............................................................................................................. 4

General Visit Utilization Pattcms ......................................................................................................... 4

Utihzation by Patient’s Presenting Symptom ........................................................................................ 6

Utilization by Physician’s Dla~osis ...................................................................................................... 7

References ................................................................................................................................................. 8

List of Detailed Tables ............................................................................................................................... 9

Appendixes

1. Technical Notes ............................................................................................................................ 22

II. Definitions of Certain Terms Used in This Report ..................... .................................................. %0

III. Survey Instruments ....................................................................................................................... 33

LIST OF TEXT FIGURES

1. Annual office visit rates for children and young adults, by age: United States, 1975 ......................... 2

2. Annual office visit rates for children and young adults, by sex and age: United States, 1975 ............ 3

3. Annual office visit rates for children and young adults, by race and age: United States, 1975 ........... 3

4. Percent distribution of office visits made by children and young adults, by physician specialty:

United States, 1975 ......................................................................................................................... 3

5. Percent distribution of office visits made by children and young adults, by physician speciaIty and

age: United States, 1975 ................................................................................................................ 5

LIST OF TEXT TABLES

A. Number, percent distribution, and number of office visits per person per year by age of patient:

United States, 1975 ......................................................................................................................... 2

B. Number of percent distribution of office visits made by children and young adults by selected

physician specialties: United States, 1975 ....................................................................................... 4

C. Percent distribution of office visits made by children and young adults by patient’s prior-visit

status: United States, 1975 ............................................................................................................. 5

D. Percent distribution of office visits made by children and young adults by seriousness of patient’s

problem: United States, 1975 ......................................................................................................... 5

...

;11
E. Percent of office visits made by children and young adults by selected reason for visit and age of

patient, with ratios of acute to chronic problems: United States, 1975 ........................................... 5

F. Mean contact duration for children and young adults, by age of patient and selected physician specialties: United States, 1975 ............................................................................................................ 6

G. Number of office visits by selected diagnoses and percent distribution of office visits made by children and young adults by physician specialties, according to selected diagnoses: United States,

1975 ................................................................................................................................................ 6

SYMBOLS

I

Data not availabIe— ———.--—.— - . .

I

I

Category not applicable——-––-–----——— . . .

I

Quantity zero–---——–———-—————

Quantity more than Obut less than 0.05-— 0.0

Figure does not meet standards of

reliability or precision (more than

30 percent relative standard error)——— *

1

iv
AMBULATORY CARE UTILIZATION PATTERNS

OF CHILDREN AND YOUNG ADULTS

Trena Ezzati, M.S., Division of Health Resources Utilization Statistics

INTRODUCTION

The data presented in this report on the utilization of office-based ambulatory care in the

coterminous United States were obtained from

the 1975 National Ambulatory Medical Care

Survey. The survey is a continuous sample survey conducted by the Division of Health Resources Utilization Statistics of the National

Center for Health Statistics. A complete description of the background and methodology of the

survey was presented in an earlier report.1

During calendar year 1975, an estimated

567.6 million office visits were made to officebased physicians in the coterminous United

States. An estimated 157 million visits, or about

28 percent, were made by persons under 22

years of age. The purpose of this report is to

present data concerning the utilization of office-based ambulatory care by these children and

young adults. The utilization statistics will be

analyzed in terms of the demographic characteristics of the patient, characteristics of the visit,

and characteristics of the physician’s practice.

Scope of the Survey

The current scope of the National Ambulatory Medical Survey (NAMCS) includes aII

office visits within the coterminous United

States made by ambulatory patients to nonfederally employed physicians who are in officebased practice. The basic sampling unit for

NAMCS is the physician-patient encounter or

visit. Excluded are visits to hospital-based physicians, visits to specialists in anesthesiology,

pathology, and radiology, and visits to physicians principzdly engaged in teaching, research,

or administration. Also excluded are visits made

by telephone and those made outside of the

physician’s office.

Source and Limitations of Data

The estimates presented in this report are

based on information obtained through completion of Patient Records (see appendix III) for a

sample of visits provided by a national probability sample of office-based physicians. The sample for the 1975 NAMCS included 3,507 physicians, of whom 438 were found not eligible (out

of scope) at the time of the survey. Of the 3,069

physicians who were eligible for participation in

NAMCS, 2,472 (80.5 percent) actually participated in the survey (see appendix I).

Sample physicians maintained a listing of all

office visits during a randomly assigned 7-day

reporting period. For a systematic random sample of these visits, information was recorded on

the Patient Record, an encounter form, provided

for that purpose (see appendix III).

Because the estimates provided in this report

are derived from a sarnple survey, the three

appendixes provide information necessary for

proper interpretation of the statistics presented.

Appendix I contains a generaI description of the

survey methods, the sample design, and the data

collection and processing procedures. Methods

of estimation and imputation are also presented.

Because the statistics in this report are based on

a sample of ambulatory visits rather than on all

visits, they are subject to sampling errors. Therefore, particular attention shotid be paid to the

section in appendix I entitled “Reliability of

1
Estimates. ” Charts of relative standard errors

and instructions for their use are given in appendix I.

Definitions of the terms used in this report

and in the survey operations are presented in

appendix II. Facsimiles of survey materials—

letter, Patient Record, and Induction Interview

Form–are reproduced in appendix III.

By means of another program of the National Center for Health Statistics (NCHS), the

Health Interview Survey (HIS), data are collected on the utilization of physician services

from a sample survey of the civilian noninstitutionalized population of the United States. The

estimates provided by HIS are generally larger

for the number of visits than NAMCS estimates

because of differences in collection procedures,

population sampled, and definitions. Data from

HIS are published in Series 10 of Vital and

Health Statistics.

DEMOGRAPHIC UTILIZATION

PATTERNS

During 1975, an estimated 157 million office visits were made by children and young

adults (CYA’S)—99 million visits by children

under 15 years and 58 million by young adults

aged 15-21 years (table A). It may be further

noted from table A that for patients of all ages

the number of office visits per person for the

year varied from a low of 1.9 for persons aged

0-15 years to a high of 4.3 per year for persons

65 years and over, reflecting a positive correlaTable A. Number, percent distribution, and number of office

visits per person per year by age of patient: United States,

1975

Age of patient

All ages ........... ...........

Under 15 years .....................

15-21 years .................. .........

2244 yaars ...........................

45-64 years ...........................

65 years and over ..................

Number

Percent Number

distri- of visits

of visits bution

in thouper perOf son per

sands visits yearl

T

567,600 100.0 2.7

99,010 17.4 1.9

58,421 10.3 2.1

171,675 30.2 2.7

145,434 26.6 3.4

93,061 16.4 4.3

tion between the annual visit rate and patient

age.

Throughout most of this report, ambulatory

pediatric visits will be analyzed according to the

following age groups since these groupings are

believed to relate closely to both the epidemiology of diseases and to the patterns of health care

of CYA’S:

Under 2 years–infants

2-5 years–preschool age

6-14 years–preadolescents-adolescents

15-21 years–young adults

Examination of the annual visit rates for

these age groups reveals that more visits were

made by children under age 2 years (4.3 per

person) than by CYA’S of any other age (figure

1 and table 1). In comparison with the other age

groups, the relatively large number of visits by

children under age 2 reflects the large number of

well-baby examinations for this age ‘woup.

,,0 ~-.--.l

Under 2 2.5 6.14 15.21

AGE (IN YEARSI

1 Rates are based on population estimates for July 1, 1975,

furnished by the U.S. Bureau of the Census (see appendix I).

2

Figure 1. Annual office visit rates for children and young adults,

by age: Unitad States, 1975.
l.o~

Under 2 2.5 6.14 15.21

AGE (IN YEARSI

Figure 2. Annual office visit rates for children and young adults.

by sex and age: United Statas, 1975 -

Annual visit rates for CYA’S according to the

sex of the patient are shown in figure 2 and

table 1. The visit rate for males slightly exceeded

that for females for chiIdren under 15 years of

age. However, for young adults aged 15-21

years, the annual visit rate for females exceeded

that for males. The Iatter finding may be a reflection of the large volume of prenatal examinations occurring for young women.

The visit rate for white CYA’S (2.1) was

higher than the rate for other races (1.3) for

each age interval (figure 3 and table 1).

PHYSICIAN UTILIZATION

PATTERNS

Visits made by CYA’S to general and family

practitioners accounted for approximately twothirds of the 157 million office visits made by

this group during 1975 (figure 4 and table 2).

Office visits to obstetrician-gynecologists accounted for about one-fifth of the visits to other

u

2

z

0

:

.

50r

4.0

3.0

I \

\

‘1

‘!

‘,

‘1

‘t

‘,

‘1

‘1

,

‘$

:

-b White

‘1

:

‘i

2.0 ‘t

‘i

;

‘i

‘i

:

;

‘1

‘1 All other

‘,

:

.

,/’

i.. ,.’

%. ,/’

●., ,,’

%. ,,’

. .

K

,,’

I

●. . ,,~

1.0 -. ,

Under 2 2.5 6-14 15-21

AGE (IN YEARS)

Figure 3. Annual office visit ratas for children and young adults,

by race and age: United States, 1975.

Figure 4. Percent distribution of office visits made by children

and young adults, by physician specialty: Unitad States,

1975.

3
specialists. Visits to the pediatrician accounted

for approximately 44 percent of the office visits

made by persons under 15 years, but for only 5

percent of those made by young adults (table

B). Visits to general and family practitioners, on

the other hand, accounted for 45 percent of the

office contacts by young adults and approximately 34 percent of the visits made by the

younger group. Characteristics of office visits to

pediatricians, general and family practitioners,

and obstetrician-gynecologists have been previously published. z -4

Further graphing of physician utilization

patterns for each age category (figure 5) reveals

that the proportion of visits to pediatricians

‘decreased as the age of the CYA visitor increased, and the proportion of visits to other

specialists increased as the age of the CYA visitor increased. For young adults aged 15-21

years, about 15 percent of the total visits were

to obstetrician-gynecologists.

Ambulatory CYA visits according to physician specialty by type and location of practice

are shown in table 3. There were more office

visits by CYA’S to, general and family practice

physicians engaged in solo practice than to those

practicing in a group or partnership arrangement. The reverse was true for those visits to

specialists in pediatrics and obstetrics-gynecology where visits to physicians in multipleTable B. Number and percent distribution of office visits made

by children and young adults by selected physician specialties: United States. 1975

Physician specialty

All specialties .........

Total ...........................

General and family practice ...

Pediatrics ...............................

Obstetrics-gynecology ...... .. ....

General surgery ......................

Internal medicine ...................

Orthopedic surgery ................

Ophthalmology ......................

Otolaryngology ......................

Dermatology ..........................

Psychiatry ..............................

Other .....................................

All ages II Under

I

15-21

15 years years

II I

Number of visits in thousands

157,431 [1 99,010 I 58,421

Percent distribution

100.0

38.3

29.3

6.1

3.9

3,6

3.6

3.6

3.5

2.7

1.4

4.0

100.0

34.1

43.7

1.1

2.6

2.1

3.4

3.4

4.0

1.3

1.0

3.3

100.0

45.5

4.9

14.6

6.0

6.3

4.0

3.8

2.7

5.1

2.4

4.7

m En

Visits to Visits to

pediatricians generaland

familv

Visiss mto

other

specialists

Under 2 2.5 5-14 15.21

AGE IIN YEARS)

57

pracsitiohers

50

Figure 5. Percent distribution of office visits made by children

and young adults, by physician specialty and age: United

States, 1975.

member practices exceeded those to solo practitioners.

Visits within standard metropolitan statistical areas (SMSA’S) (73 percent) outnumbered

nonmetropolitan visits (27 percent) for all visits

made by CYA’S to physicians’ offices.

UTILIZATION BY VISIT

CHARACTERISTICS

General Visit Utilization Patterns

Information abstracted from the Patient

Record (see appendix III) concerning the

patient’s prior-visit status reveals that the majority of visits (82 percent) made by CYA’S were

return visits (table C).

Proportionately, there were more new

patient visits by children under 6 years of age

than by CYA’S 6 years and older (table 4).

Survey results show that ambulatory pediatric care included a large proportion of problems considered not serious and slightly serious

4
Table C. Percent distribution of office visits made by children

and young adults by patient’s prior-visit status: United

States, 1975

Percent

Patient’s prior-visit status distribution

Total .............................................................. 100.0

New patient .............................................................. 17.9

Return patient:

New problem ....................................................... 33.0

Old problem ........................................................ 49.1

Table D. Percent distribution of office visits made by childran

and young adults by seriousness of patient’s problam:

United States, 1975

Percent

Degree of seriousness distribution

~

Total ..............................................................

..............................................

..........................................................

Not serious................................................................

(table D); seriousness of problem is defined as

the physician’s judgment of the extent of impairment that might result if no care were

obtained (see appendix II). Data (table D) on

the physician’s judgment of the seriousness of

the patient’s problem, complaint, or symptom

show that over one-half of the problems presented by CYA’S were considered “not serious,”

a reflection of the large volume of well-person

examinations and acute, self-limiting problems

characteristic of CYA’S. The statistics in table E

show that an acute conditions (55 percent) was

the major categorical reason for visit. Chronic

problems,b on the other hand, accounted for 17

percent of the CYA visits. The ratio of acute

problems to chronic problems tended to decrease with age (table E). In other wor&, the

proportion of visits at which a chronic problem

was involved tended to increase as the age of the

patient increased. The percents in table E also

show the proportion of visits involving routine

well-person examinations decreasing as the patient’s age increases.

For CYA’S, a limited history or examination

characterized approximately 50 percent of the

visits (table 5). GeneraJ history or examination

and clinical laboratory tests each accounted for

about 20 percent of the visits. Proportionately

more clinical laboratory tests were performed

for young adults aged 15-21 years than for children of any other age. It may be further noted

that the proportion of visits in each age category

involving a blood pressure check increased with

age. Data in table 5 show that prescription of

drugs (42 percent) was the most common therapeutic-type service.

Followup care of some type was advised at

the majority of CYA visits. At about 47 percent

of the visits, the patient was advised to return at

a specified time; about one-fifth of the visits

entailed no followup plans (table 5).

Duration of visit represents the amount of

time spent by the patient in face-to-face contact

with the physician. The average encounter time

for all CYA visits was about 13 minutes. Table F

shows the mean duration of visit for the four

CYA age groups and for the five most frequently

visited specialists.

Table E. PerCant of office visits made by children and young adults, by selected categorical reason for visit and age of patient, with ratios

of acute to chronic problems: United States, 1975

Age of patient

Categorical reason for visit All

ages Under 2 2-5 6-14 15-21

years years years years

Acute problem ..................................................................................................................... 54.5 4s.7

Chronic problem

65.3 5s.3 49.0

.................................................................................................................. 17.4 8.7 13.4 20.7 20.4

Well-adult and well-child examinations ................................................................................. 17.6 40.6 17.4 13.0 11,3

Ratio of acute to chronic problems ...................................................................................... 3.1 5.6 4.9 2.8 2.4

‘An acute condition is defined as a condition or illness having a relatively sudden or recent onset (i.e., bA chronic problem is defiied as a condition or iUwithin 3 months of the visit). ness with an onset 3 months before the present visit.

5
Table F. Mean contact duration for children and young adults,

by age of patient and selected physician specialties: United

States, 1975

Age of patient and physician specialty

Total ..............................................................

Aae

Under 2 yearn ...........................................................

2-5 yea~ .............. ........ .............................................

6-14 years .................................................................

15-21 years ...............................................................

Specialty

General and family practice ......................................

Pediatrics ......... ........................................ ........ .........

Obstetrics-gynecology ................ ..............................

General surgary ........................................................

Internal medicine ............ ................ ............ .............

Mean

contact

duration

(in minutes) 1

12.6

11.2

11.3

12.9

13.5

10.8

12.1

12.4

11.5

15.6

lTime spent in face-to-face contact between physician and

patient.

Utilization by Patient’s Presenting

Symptom

One unique aspect of NAMCS is the attempt

to measure the major reason for visit as reported

in the patient’s own words (question 5 of the

Patient Record). However, the reliability of

these data may be somewhat limited for children, for whom the reason for visit may frequently be reported in the words of the parent

or accompanying adult(s). The patient’s problems, complaints, or symptoms are coded according to a special classification developed for

use in NAMCS.5

A rank ordering of the 54 most frequent

problems, complaints, or symptoms as presented

in the words of the CYA visitor (or in the case

of children, in the words of the accompanying

parent or adult) is shown in table 6. These

symptom data represent the problems, complaints, or symptoms listed first in item 5 of the

Patient Record (see appendix III). Because of

sampling variability, this ranking of problems

does not represent true statistical difference

Table G. Number of office visits by selected diagnoses and percent distribution of office visits made by children and young adults by

phvsician specialties. according to selected diagnoses: United States. 1975

10 most frequent diagnoses of ii Iness-related conditions and ICDA codel

Number

of office

visits in

thousands

All diagnoses .......................................................... ............... ...........................

Acute upper respiratory infection .................. ............................................................465

Otitis media .. ........................................................ .....................................................38l

Acute pha~ngitis ................................. .................................................... ..................462

Acute tonsillitis ............................ ..............................................................................463

Other eczema and dermatitis .................................................................... ..................692

Bronchitis, unqualified ........................ .. ...... .. ........ ............ .......... ...... ................ .........49O

Hay fever .............. ...... ...............................................................................................5O7

Other viral diseases ............ .........................................................................................o79

Asthma ................................................................................................... .......... .........493

Strerxococcel sore throat and scarlet fever ......... .. ............ .......... ...... ..........................O34

157,431

8,220

7,597

4,597

4,543

4,158

3,280

2,968

2,620

1,753

1,706

ImPhysician specialty

General

Total or

fam- Pedi- All

ily atrics other

practice

Percent dktribution

100.0 II 36.3

1

100.0 53,1

100.0 30.0

100.0 61.6

100.0 54.3

100.0 49.0

100.0 40.7

100.0 33.8

100.0 33.4

100,0 28.9

100.0 47.9 !

29.3 32.4

35.6 11.3

49.9 20.1

39.5 *8.9

32.5 13.2

36.2 14.8

52.7 *6.6

32.0 34.2

26.8 37.8

38.9 32.2

44.9 *7.2

lBa~ed on Eighth Revim”onInternationalClassijTcationof Diseases, Adapted for Use in the United States. 1965 (ICDIA) (see

reference 6).

6
among the estimates. These symptom data show

that among the 157 million total CYA visits,.

sore throat and well-baby examination each

accounted for about 5 percent of the total.

Examination of table 7 reveals a difference

in the spectrum of presenting symptoms among

the various age groups. As might be predicted,

the well-baby examination was the most common reason for visit for the youngest age group

(1,387 per 1,000 persons) and pregnancy examination was the most common reason for office

visits made by persons aged 15-21 years (210 per

1,000 persons).

Utilization by Physician’s Diagnosis

Information concerning principal diagnoses

for CYA’S (table 8) reveals that diagnoses rendered by physicians most frequently fell into the

category of “special conditions and examinations “C (25 percent) or diseases of the respiratory system (22 percent).

The most frequent individual ICDA diagnoses for CYA visitors are ranked according to

their frequency of occurrence in table 9.

Visit rates by age for selected CYA diagnoses

(table 10) show that for otitis media and for

conditions associated with the respiratory system, the annual visit rate tended to decrease

with increasing age. Only for acute tonsillitis was

this pattern altered-the annual visit rate for

children aged 2-5 years exceeded that for children under age 2.

Although the proportion of visits to general

and family practice physicians and pediatricians

for selected diagnoses (table G) differed, otiy

for acute upper respiratory infection, otitis

media, and acute tonsiIEtis were the differences

statistically significant.

~,,~pecid ~Onditionsand examinations” is a supplementaryclassification(codes YOO-Y13) of the international Classification of Dkeases, Aakpted for Use in the

United States, 1965 (ICDA). Included in this category,

for example, are medical or special examination (YOO),

persons receiving prophylactic inoculation and vaccination (Y02), and prenatal care (Y06) (see reference 6).

000
REFERENCES

1National Center

Ambulatory Medical

methodology, United

and others. Vital and

for Health Statistics: National

Care Survey: Background and

States, 1967-72, by J. B. Tenney

Health Statistics. Series 2-No. 61.

DHEW Pub. No. (HRA) 74-1335. Health Resources

Administration. Washington. U.S. Government Printing

Office, Apr. 1974.

2National Center for Health Statistics: Ambulatory

medical care rendered in pediatricians’ offices during

1975, by T. Ezzati. Advance Data From Vital and

Health Statistics, No. 13. DHEW pub. NO. (HRA)

77-1250. Health Resources Administration. Hyattsville,

Md. Oct. 13, 1977.

3National Center for Health Statistics: National

Ambulatory Medical Care Survey of visits to general and

family practitioners, January-December 1975, by B. K.

Cypress. Advance Data From Vital and Health Statistics,

No. 15. DHEW Pub. No. (HRA) 78-1250. Health

Resources Administration. Hyattsville, Md. Dec. 14,

1977.

4National Center for Health Statistics: Office visits to

obstetrician-gyne colonists: National Ambulatory Medical

Care Survey, United States, 1975, by T. Ezzati. Ad~ance

Data From Vital and Health Statistics, No. 20. DHEW

Pub. No. (HRA) 78-1250. Health Resources Administration. Hyattsville, Md. Mar. 13, 1978.

5National Center for Health Statistics: The National

Ambulatory Medical Care Survey: Symptom classification, by S. Meads and T. McLemore. Vital and Health

Statistics. Series 2-No. 63. DHEW Pub. No. (HRA)

74-1337. Herdth Resources Adminktration. Washington.

U.S. Government Printing Office, May 1974.

6Nationa1 Center for Health Statistics: Eighth Revision International classificationof D~e~% Ad@ted for

Use in the United States. PHS Pub. No. 1693. Public

Health Service. Washington. U.S. Government hinting

Office, 1967.

7Nation~ Center for He~th Statistics: Replication:

An approach to the analysis of data from complex surveys, by P. J. McCarthy. Vital and Health St(ztistics.

Series 2-No. 14. DHEW Pub. No. (HSM) 73-1269. Health

Services and Mental Health Administration. Washington.

U.S. Government Printing Office, Apr. 1966.

8National Center for Health Statistics: Pseudoreplication: Further evaluation and application of the balanced

half-sample technique, by P. J. McCarthy. Vital and

Health Statistics. Series 2-No. 31. DHEW Pub. No.

(HSM) 73-1270. Health Services and Mental Health

Administration. Washington. U.S. Government Printing

Office, Jan. 1969.
LIST OF DETAILED TABLES

1. Number and percent distribution of office visits and visit rates for children and young adults by age, sex, and race of patient:

United States, 1975 .................................................................... .......................................... ........................................................

2. Number and percent distribution of office visits made by children and young adults by selected physician specialties, according to age of patient: United States, 1975 ............................. .................................................... ...................................................

3. Number and percent distribution of office visits made by children and young adults by selected physician specialties, according

to type, region, and location of practice: United States, 1975 ................................................................ .................................... ..

4. Number and percent distribution of office visits made by children and young adults by prior-visit status, seriousness of problem, and selected major reasons for visit, according to age of patient: United States, 1975 ..........................................................

5. Number and percent of office visits made by children and young adults by selected visit characteristics and age of patient:

United States, 1975 ........................................................................................................... ... .................. ................................ ......

6. Number, percent distribution, and cumulative percent of office visits made, by children and young adults by the 54 most frequent patient problems, complaints, or symptoms: United States, 1975 ............... .................................................................... ...

7. Number and percent distribution of office visits and visit rates for children and young adults, by age of patient and the most

frequent patient problems, complaints, or symptoms: United Statas, 1975 ................................................................................ ..

8, Number and percent distribution of office visits made by children and young adults by sex, race, and age of patient, according

to principal diagnosis: United States, 1975 ................................................................................................................. ..................

9. Number, percent distribution, and cumulative percent of office visits made by childrenand young adults, by the 54 most common physician diagnoses: United States, 1975 ............................................................. ................................................................

10. Number of office visits and visit rates for selected diagnoses for children and young adults by age of patient: United States,

1975 .............................................................................................................................................................................................

10

11

11

12

13

14

15

17

18

19

9
Table 1. Number and percent distribution of office visits and visit rates for children and young adults by age, sex, and race of patient:

United States, 1975

Patient characteristic

All visits ...............................................................................................................................

Age

Under 2 yeaw .......................................................................................................................................

2-5 years ................................................................................................................................ ...............

6-14 years ....................................................................................... ......................................................

15-21 years ...................................................................................................... .......................... ...........

Sex and age

Under 2 years ................................................................................. ...... ........ ........................ ......... .......

2-5 years ........................................................................ ................ ........ ................................ ...............

6-14 years .............................................................................................. .................................. .............

15-21 years ...................................................... .................................................................... ................

Under 2 years ............................................. .......................................... ...................... ..........................

2-5 years ............<... .................................................... ...........................................................................

6-14 years ................................................................................................................................ .............

15-21 years ...........................................................................................................................................

Race and age

Under 2 years .......................................................................................................................................

2-5 years ................................................... ............................................................................. ...............

6-14 years ............... ................................................................................................................. .............

15-21 years ................................................................................................................................ ...........

All other .......................................................................................... ..........................................

Under 2 years .......................................................................................................................................

2-5 years .................................................................................... ........................................................ ...

15-21’ years ................................................. ................................ ................ ........ ........ ............... ...........

Number

of visits

in thousands

157,431

25,598

26,784

46,628

58,421

83.254

12,255

11,993

21,893

37,113

74,177

13,343

14,792

24,735

21307

140,742

22,026

23,874

42,266

52,576

16,669

3,572

2,910

4,362

5p45

Percent

distribution

of visits

100.0

16.3

17.0

29.6

37.1

52.9

7.8

7.6

13.9

23.6

47.1

8.5

9.4

15.7

13.5

89.4

14.0

15.2

26.8

33.4

10.6

2.3

1.8

2.8

3.7

Number

of visits

per person per

yearl

2.0

.—.—

4.3

2.1

1.4

2.1

2.1

4.2

1.9

1.3

2.7

1.8

4.4

2.2

1.5

1.5

2.1

4.5

2.2

1.5

2.2

1.3

3.5

1.3

1.0

1.4

1 Ra~e5 are ba5ed on population ~stimates for July 1, 1975, furnished by the U.S. Bureau of the Census (see aPPendlx 1)<
Table 2. Number and percent distribution of office visits made by children and young adults by selected physician specialties, according

to age of patient: United States,

Physician specialty

All specialties .........................................................................................

Total ............................................................................................................

General and family practice ....................................................................................

Pediatrics................................................................................................................

Obstetricsgynecology ............................................................................................

General surgery ......................................................................................................

Internal medicine ...................................................................................................

Orthopedic surgery.................................................................................................

Ophthalmology ......................................................................................................

Otolar%ngokrgy ......................................................................................................

Dermatology ..........................................................................................................

Psychiatry ..............................................................................................................

II Age of patient

All ages Under 2 2-5 6-14 15-21

years yaars years years

Number of visits in thousands

157,431 II 25,598 I 26,764 [ 46,628 I 58,421

Percent distribution

100.0 100.0 100.0

38.3 31.7 31.9

29.3 56.5 51.1

6.1 ●1.9 *0.6

3.9 ●1.4 ●1.7

3.6 ●0.8 ●1.4

3.6 3.4 2.3

3.6 ●1.O 1.9

3.!5 ●1.3 4.6

2.7 ●0.5 ●0.5

1.4 ●0.O ●0.3

4.0 ●1.!5 3.7

100.0

36.7

32.4

*0.9

3.8

3.1

4.0

5.6

5.1

2.2

1.4

4.8

100.0

45.5

4.9

14.6

6.0

6.3

4.0

3.8

2.7

5.1

2.4

4.7

Table 3. Number and percent distribution of office visits made by children and young adults by selected physician specialties, according

Physician specialty

All specialties .....................

General and family practice ...............

Pediatrics ...........................................

Obstetrics-gynecology ........................

General surgery ..................................

Internal medicine ...............................

Orthopedic surgery ............................

Ophthalmology ..................................

Otolaryngology ..................................

Dermatology ......................................

Psychiatry ..........................................

type, ragi

Number

of visits

in thousands

157,431

60,338

46,112

9,631

6,135

5,707

5,697

5,603

5,522

4,247

2,132

, and location of practice: United States, 1975

Type of

Region Location of

practice prect ice

Total North Metro- NonSolo Otherl

North- Cen- South westmetroeast politral tan2

politan

Percent distribution

100.0 n 54.2

1

100.0 67.9

100.0 41.6

100.0 36.7

100.0 58.7

100.0 56.7

100.0 42.5

100.0 70.3

100.0 15.7

100.0 57.6

100.0 83.6

45.8

32.1

58.4

63.3

41.3

43.3

57.5

29.7

84.3

42.4

●16.4

22.2

15.1

31.0

16.5

20.6

32.5

22.2

29.1

10.3

15.3

46.3

28.5

36.0

25.7

24.4

23.3

31.9

16.1

21.3

26.0

*4.5

●11.5

32.3

31.7

27.9

41.7

44.7

23.1

42.8

i?fl.7

37.8

56.8

26.5

17.1

17.2

15.4

17.3

11.4

12.4

18.8

19.9

25.9

21.5

●15.6

73.4

57.6

89.1

74.8

65.4

80.3

82.5

83.5

64.8

78.6

97.8

26.6

42.4

10.9

25.2

34.6

19.7

17.5

16.5

35.2

21.4

*2.2

lIncludes ~oup and partnership.

2Located within the standard metropolitan statistical areas (SMSA’S).

11
Table 4. Number and percent distribution of office visits made by children and young adults by prior-visit status, seriousness of Droblem.

and selected major reasons for visit, according to age of pa~ent: United States, 1975

Visit characteristic

All visits ................................................................ .................................

Prior-visit status

New patient ........................................................................... .......... .......................

Old patient, new problem ................................................................................ .......

Old patient, old problem ....................................................... ................ .................

Seriousness of problam

Serious or very serious ... .................................. ...... ................ .......... .......................

Slightly serious ................................................. .............. ........................................

Not serious .............................................................................................................

Maior reason for visit (selectad reasons)

Acute problem .......................................................................................................

Acute problem, fol lowup ................................................................................ .......

Chronic problem, routine ........... ........................ ........ ........ ...... .. ........ ....................

Chronic problem, flareup .......................................................................................

Well*dult and well-child examinations ...................................................................

Number of visits in thousands

157,431 ![ 25,598 I 26,764 [ 46,628 [ 58,421

Percant distribution

100.0

17.9

33,0

49.1

11.3

30.0

58.7

43.3

11.2

11.9

5.5

17.6

100.0

13.7

35.2

51.1

8.9

23.1

67.9

39.6

9.1

5.5

3.2

40.6

100.0

13.3

37.0

49.7

12,9

33.7

53.5

53.9

11.4

8.8

4.6

17.4

100.0

18.6

34.9

46.!5

11.6

33.5

54.9

47.0

11.3

14.8

5.9

13.0

100.0

21.3

28.8

49.8

11.4

28.5

60.1

37.1

11.9

13.7

6.7

11,3

12
Table 5. Number and percent of office visits made by children and young adults by selected visit characteristics and age of patient:

United States, 1975

Selected visit characteristic

All visits ............................ .....................................................................

Services ordered or orovided

No services .................................................................................... .........................

Diagnostic service:

Limited history, examination ........ ............................................ ........................

General history, examination .................................................................. ..........

Clinical lab test ........... .......................... .................................................. ..........

Blood pressure check ............... .................... .....................................................

X.ray ........................................................ .................. .......................................

Vision test ......................................................................... ........ .............. ..........

Hearing test ..................................................................................................... ..

Therapeutic service:

Drug prescribed or dispensed ................................ ............................................

Immunization or desensitization .............. ........................................................ .

Medical counseling ...................................................................... .. ............ .. ......

Injection .................................... .. .....................................................................

Office surgery .............. ........ ........ .................... ................ .................................

Dis~osition

No followup planned ......................... .....................................................................

Return at specified time ............... ............................ ..............................................

Return, if needed, P.R.N . .................................................................. ....................

Telephone followup planned ................................................ ..................................

Referred to other physician/agency .................... ........................................ ............

All ages

Age of patient

Under 2 2-5 6-14 15-21

years years years years

Number of visits in thousands

157,431 II 25,598 I 26,764 I 46,628 I 58,421

3.4

49.8

20.3

19.9

15.3

5.7

5.2

2.0

42.0

10.3

12.0

10.8

6.9

21.3

47.3

24.9

5.1

2.5

Percent of visitsl

3.8

43.5

33.2

12.7

2.9

2.2

*0.9

*0.4

37.8

24.7

16.2

11.7

2.2

14.0

60.1

20.7

4.5

*1.5

3.7

51.0

20.2

18.9

6.0

4.0

5.0

3.3

47.8

12.9

11.0

12.6

5.0

24.4

39.0

29.3

7.2

2.6

3.2

49.9

17.7

16.7

10.6

7.7

7.3

2.7

41.2

10.4

10.9

10.1

8.6

25.0

40.6

26.8

6.5

2.7

3.3

52.0

16.8

26.1

28.8

6.3

5.5

1.6

41.9

2.8

11.6

10.2

8.6

20.1

50.9

23.3

3.4

2.8

lpercent~maY total more than loo. osincemor etha nonetreatment ormore than one disposition could begiven ata single visit.

13
Table 6. Number, percent distribution, and cumulative percent of office visits made by children and young adults, by the 54 most

frequent patient problems, complaints, orsymptoms: United States, 1975

Problems, complaints, or symptoms and NAMCS code]

All visits . .......................................................................................................................... ... ....

1. Sore throat ......................................................... .................................. .....................................52O

2. Well*aby examination ......................... ........ ..................................................... ........................9O6

3. Cough ...................... ............................................................................ ......................................3l 1

4. Pregnancy examination, routina .... .. .......<............ ......................................................................9O5

5. General medical examination ...................................... ........................ ................................ .......9OO

6. Fever ............................................................ ...................................................... .......................OO2

7. Phvsical examination ....... ...................................................................<.................... ..................9ol

8. Surgical aftercare .......................................... .............................. ...............................................986

9.

10.

11.

12.

13.

14.

15.

16.

17.

18.

19.

20.

21.

22.

23.

24.

25.

26.

27.

28.

29.

30.

31.

32.

33.

34.

35.

36.

37.

38.

39.

40.

41.

42.

43.

44.

45.

46.

47.

48.

49.

50.

51.

52.

53.

54.

55.

Visit for therapy, medication ............................... ...... .. ...... ........................................................9lo

Earache ............................... ........ ........ .......................................................................................735

Allergic skin reactions ................................ ................................................ ................................l 12

Cold .......................................................................... .. ........................ ...... .................................3l 2

Problem, lower extremity ........................................................................ .......... ........................4OO

Abdominal pain ......................................................... ................................................................MO

Wounds of skin ................... ............................................................................ ...........................116

Problem, upper extremity ... ............................................ .......................... ...... ...........................4O5

None ......................... .......... ........ .............. .... ............................. ................................................ 997

Headache ...................................................................................................................................O56

Eye examination ...................................... .. ...................... ..........................................................908

Acne or pimples ............................... ...................... ....................................................................lOO

Nausea and vomiting ............... ...................................................................................................572

Gynecologict4 examination ............................................................ ........ ....................................904

Othar symptoms–ears .......................................................................... ........................ ........ .....74O

Problem, face and neck region ....................... .. ...................... ........................ ............................41 O

Nasa I congestion ............. ...... .. ................ ............................................................................ .......301

Swalling or mass of skin ... .............................................. .............. .. ................ ...... ......................l 15

Warts ............................................................................................ .............<...............................l 11

Other vision dysfunction ................ ...... .. .................... ........ .......... ............................ .................7Ol

Pain, back region ........................... ..... ......................... ..............................................................4l 5

Other symptoms referable to the respiratory system .................................................................33O

Skin irritations, NEC .................................................. .............. ...................... ........ ...................l 13

Vaginal discharge ................ ....................................................... ............ ....................................662

Hay faver ............................................................................................ ...... .............................. ... 329

Other specific symptoms referable to skin .................................................................................l2O

Menstrual disorders ............. ............................................................ ...........................................653

Problems, NEC ........................................................................ ..................................................99O

Visit for laboratory test ................................................................. ............................................920

Diarrhea ................................................................................. ...................... ..............................555

Fatigue ......................................................................................................................................oo4

Eye pain and irritation ........................................... ....................................................................7O5

Other hearing dysfunctions ........... ...................................................................... .....................!.73l

Pain in chest .................. ................................ ........................ .................................................... 322

Weight gain ........................................... .............................. .......... ...................... ....................... 010

Asthma ................................................. .............................................. ....................................... 328

Symptoms raferable to tonsils ........ ...... .. ............................................................ .......................527

Visit for advice, situational problems .................................................. .......................................94l

Visit for family planning services–medication ...................... ........ .............................................931

Swollen lymph glands ................................................. ...............................................................232

Painful urination ................................................... ........................ ............ .......... .......................604

Other disorders of respiratory rhythm and sound ......................................................................3O7

Otharsymptoms, mental health .......................... ................................ ............ ........ .......... .........83O

Abdominal swelling or mass ................................................................ ............ ........ .. .................542

Visit for advice and instructions ........ ........................ .................................................... ............94O

Other symptoms, limb and joint ......... ........................ ....................... ...................... ..................422

Other .......................................................................... ...................................................... ...............

of visits

in thousands

157,431

8,503

8,291

6,564

6,398

6,248

5,820

5,740

5,450

5,255

5,187

4,671

4,373

4,361

3,391

3,342

3,122

2,293

2,017

1,975

1,908

1,788

1,694

1,670

1,574

1,568

1,521

1,458

1,428

1,402

1,348

1,072

1,056

989

980

959

906

890

875

863

722

700

657

647

630

609

607

602

576

563

552

552

547

542

506

29,469

Percent

distribution

of visits

100.0

5.4

5.3

4.2

4.1

4.0

3.7

3.7

3.5

3.3

3.3

3.0

2.8

2.8

2.2

2.1

2.0

1.5

1.3

1.3

1.2

1.1

1.1

1.1

1.0

1.0

1.0

0.9

0.9

0.9

0.9

0.7

0.7

0,6

0.6

0.6

0.6

0.6

0.6

0.6

0.5

0.4

0.4

0.4

0.4

0.4

0.4

0.4

0.4

0.4

0.4

0,4

0,4

0.3

0.3

18.7

Cumw

Iative

percent

100.0

5.4

10,7

14.9

19.0

23.0

26.7

30.4

33.9

37.2

40.5

43.5

46,3

49.1

51.3

53.4

55.4

56.9

58.2

59.5

60.7

61.8

62.9

64.0

65.0

66.0

67.0

67.9

68.8

69.7

70.6

71.3

72.0

72.6

73,2

73.8

74.4

75.0

75.6

76.2

76.7

77.1

77.5

77.9

78.3

78.7

79.1

79.5

79.9

80,3

80.7

81.1

81.5

81.8

82.1

100,0

1Problems and codes based on a symptom classification developed for use in the NAMCS (see reference 5).

NOTES: Percenta maynottotallOO.O duetoroundlng. NEC-not elsewhere classified.

14
Table7. Number and percent distribution of office visits and visit ratasfor children and young adults, byageof patient and the most

freouent . oetient . Drobiems.,..comDiaints. orsvmDtoms: . . United States. 1975

Age and problems, complaints, or symptoms and NAMCS codel

All ages....................................................................................................................................

Under 2 years

Well-baby examination .......................................................................................................................806

Fever..................................................................................................................................................~2

Cough ................................................................................................................................ ................ 311

Allergic skin reactions ..“......................................................................................................................112

Visit for therapy, medication .............................................................................................................9lo

Diarrhea .............................................................................................................................................555

Nausea and vomiting ..........................................................................................................................572

Nasal congestion ................................................................................................................................3Ol

Other .......................................................................................................................................... .............

2-5 years

General medical examination .............................................................................................................9W

Cough ................................................................................................................................................3l 1

Sore throat ................................................................................................................................ ......... 520

Visit for therapy, medication .............................................................................................................910

Allergic skin reactions ........................................................................................................................112

Surgical aftercare ...............................................................................................................................986

Physical examination .........................................................................................................................wl

Wounds of skin ..................................................................................................................................l 16

Nausaa and vomiting ..........................................................................................................................572

Other symptoms–ears ........................................................................................................................74o

Other ............................................................................................................................................... ........

6-14 years

Total ................................................................................................................................. ............

Sore throat .........................................................................................................................................52o

Visit for tharapy, medication .............................................................................................................9lo

Ganeral medical examination .............................................................................................................9w

Earache ..............................................................................................................................................735

Surgicel aftercare ...............................................................................................................................986

Cough ...................................................o............................................................................................3l 1

Physical examination .........................................................................................................................

Problem, lower extremity ..................................................................................................................z.

Fever..................................................................................................................................................oo2

Wounds of skin ................................................................................................................................ ..116

Problem, upper axtramity ..................................................................................................................405

Number

of visits

in thousands

157,431

25,598

8,225

1,850

1,479

1,197

1,080

984

596

532

*442

*437

8,766

26,784

2,499

2,241

2,115

1,643

1,446

1,215

1,147

1,030

938

906

793

●465

*401

9,944

46,628

3,851

2,375

2,197

2,059

2,039

1$12

1,812

1,634

1,443

1,410

1,407

Percent

distribution

of visits

100.0

100.0

32.1

7.2

5.8

4.7

4.2

3.9

2.3

2.1

1.7

1.7

34.2

100.0

9.3

8.4

7.9

6.1

5.4

4.5

4.3

3.8

3.5

3.4

3.0

1.7

1.5

37.1

100.0

8.3

5.1

4.7

4.4

4.4

4.1

3.9

3.5

3.1

3.0

3.0

Visit

rate

per

1,000

persons

per

year2

1,954

4,318

1,387

312

249

202

182

168

101

90

75

74

1,478

2,064

193

173

163

127

111

94

88

79

72

70

61

36

31

766

1,396

115

71

66

62

61

57

54

49

43

42

42

See footnotes at end of table.

15
Table 7. Number and percent distribution of office visits and visit rates for children and young adults, by age of patient and the most

frequent patient problems, complaints. or svmptoms: United States. 1975–Con.

Age and problems, complaints, or symptoms and NAMCS codel

6-14 years-Con.

Allergic skin reatiions ..................................... ....................... ........................... .................................l 12

Abdominal pain ............................................................. ................ ................ ....................................54o

Cold ........................................ .......... .............. ................................ ...................................................3l2

Eye examination ........... ........................................................ .............................................................9O8

Headache .............................................................................. ................. ................ ............................O56

Other vision dysfunction ......... ........ ........ .......................................... ........ .............................. ...........7ol

Warts .............................................................................................................. .. .............. .................... 111

Other symptoms.ears ........................................................................................................................74O

Hay fever ......................... .......... ........ .............................. ..................................................................329

Problem, face and neck region .... .............. .............................. ................ ...........................................4IO

Nausea and vomiting ................. ................ ........ ........ .........................................................................572

Other ................................................................................................................................ .......................

15-21 years

Total ............... ................................................................................ ............................................. .

Pregnancy examination, routine .................................................................................. .......................9O5

Sore throat ........................................... .............................. .......................... ............................. ......... 520

Physical examination .. .......................... ................ ..... ........................... .............................................9ol

Problem, lower extremity ............................. .....................................................................................400

Surgical aftercare ............................................................................... ........................ ........................ 986

Abdominal pain .................................................................................................... .............................54o

Gynecological examination ................................................................................................................9o4

Acne or pimples ......................................................................................... ........................................loo

Problem, upper extremity .......................................................................................................... ........4O5

Allergic skin reactions ................................................................. ................ ...................... .................ll2

General medical examination ................ .............................................................................................9oo

Painr back region ................................... ............................................................................ .................

Cold

415

........................... ................................................................ .................. ......................................3l 2

Cough ......................................................................................................... .......................................3l 1

Wounds of skin ............................. ............................................................................ ...... ................. .. 116

Eye examination ........ ........................ ...................................................................... .................. ........9O8

Vaginal discharge .............................................................. ........................ ........ .................................662

Earache ................................. .............................................................................................................735

Menstrual disorders ............................... ...... ................ .......................................................................653

Swalling or mass of skin ................ ........ ......................................................." ....................................l 15

Problemr t%ce and neck region ..................... ...... .......... ...................... ........ .................................... ....4IO

Warts ..................................................... .................................................. ......... ..................................l 11

Visit for therapy, medication ............................... .................... ................................ ...... ....................9lo

Fat igue ...............................................................................................................................................oo4

Visit for laboratory test ............................................................ .......... ...............................................92O

ViSit fOr family planning services-medication ................... .................. ..............................................93l

Other vision dysfunction .................................................... .................. ..............................................7ol

Other .............................................. ...................................................... ............................................ .......

of visits

in thousands

1,261

1,237

959

871

846

845

642

!559

536

529

508

15,694

58,421

5,941

2.963

2,892

2,122

2,080

1,735

1,625

1,518

1,364

1,300

1,165

1,075

1,070

1,058

1,004

985

932

889

888

771

749

705

672

623

608

600

501

20,586

Percent

distribution

of visits

2.7

2.7

2.1

1.9

1.8

1.8

1.4

1.2

1.1

1.1

1.1

33.7

100.0

10.2

5.1

5.0

3.6

3.6

3.0

2.8

2.6

2.3

2.2

2.0

1.8

1.8

1.8

1.7

1.7

1.6

1.5

1.5

1.3

1.3

1.2

1.2

1.1

1.0

1.0

0.9

35.2

Visit

rate

per

1,000

persons

per

year2

38

37

29

26

25

25

19

17

16

16

15

470

2,068

210

105

102

75

74

61

58

54

48

46

41

38

38

37

36

35

33

31

31

27

27

25

24

22

22

21

18

729

lProb]ems and codes based on a symptom classification developed for use in the NAM~ (see reference 5).

2Rates are based on population estimates for July 1, 1975, furnished by the U.S. Bureau of the Census (see appendix I).

16
Table 8. Number and Dercent distribution of office visits made bv children and voung adults by sex, race. and me of Patient, according to Principal dh9no$is:

United States, 1975

Principal diagnosis classified by ICDA categoryl

All diagnoses .............. ...................... .. ........................ .........

Infective and parasitic dseasm ........................................ .......~l.l36

Neoplasms .... .................... .......... ................................... .........l4O.239

Endocrine, nutritional, and metabolic diseases.......................24O-27S

Mental disorders .................................. ........... .. ........... .. .........mo.3l5

Diseases of nervous system and sense orgens .. ........................320.389

Diseases of circulatory system ............... ......... ............. ...........39O458

Diseases of respiratory sy$tem ........... ............. .. ......................46O.5l9

Diseases of digestive system ... ........... .. ...................................52O.577

Diseases of genitourinary system ..... .. ...................... .. .............WO%29

Diseases of skin and subcutaneous tissue..,..., ............ .............6BO.7O9

Diseases of musculoskeletal system ............ .... ........................710-736

Symptoms and illdefined conditions ........................ .............780-796

Accidents, poisonings, and violence ............. ..........................800-999

Special conditions and examinations without sickness ......... YOO-Y13

Other dagnos=2 .................. ........... ........... .. .. .................... ....... ..........

Diagnoses given as '' None'' ..................... ............... ..............................

Diagnoses unknown3 ....... ............. .................... ........................ ..........

Number

of visits

in thou157,431

10,466

1,246

2,309

3,671

15,341

1,142

35,238

3,376

6,079

11,252

3,021

6,772

13,385

39,6SS

2,611

825

601

II Sex I Race I AW

Total FeMale White

All Under 2 2-5 6-14 15-21

male other years years years years

Percent distribution

100.0 II 52.9

1

100.0 57.5

100.0 72.3

100.0 65.5

100.0 46.5

100.0 51.1

100.0 47.4

100.0 46.6

100.0 52.2

100.0 79.4

100.0 53.3

100.0 42.8

100.0 52.5

100.0 35,5

100.0 57.8

100.0 57.4

100.0 ●47.5

100.0 %0.5

47.1 [ 89.4

42.5 89.0

27.7 91.9

34.5 89.8

51.5 92.2

46.9 92.4

52.7 79.7

51.4 89.2

47.9 89.5

20.6 83,0

46.7

57.2 E.:

47.5 88.3

64.5 89.1

42.2 89.4

42.6 67.5

“52.5 93.0

●49.5 90.7

10.6

11.0

8.1

10.3

‘7.8

7.6

20.3

10.8

●10.5

17.0

10.6

●6.6

11.7

11.0

10.6

*1 2.5

●7.O

*9.3

16.3

_

15.5

“13.6

%5

“2.9

15.8

“7.3

16.8

“13.4

●2.8

10.3

●14.2

10.3

4.8

26.6

24.4

‘18.0

●8.6

17.0

16.8

●9.3

“7.0

“4.0

23.9

*1O.4

25.1

●11.6

10.0

12.2

“1 1.0

17.1

14.8

13.9

●16.0

“11.3

●0.6

28.6

35.2

●1 5.9

22.7

34.6

35.7

“22.7

33.8

28.1

16.3

33.3

2%6

34.8

36.4

20.6

30.1

“27A

“33.1

37.1

-

32.6

61.2

61.8

R

69.6

24.3

46.9

70.9

44.2

45.2

37.8

44.1

36.6

29.5

‘ 43.7

“57.7

1Based on the Eighth Revision International Classification of Diseases, Adapted for Use in the United States, 1965 (ICDA) (see reference 6).

2280.289. Diseases of the blood and blood. forminR ormns; 63 0.678. Comvlicatiom of~remancy, childbirth, andthepuerperium ;740-759, Congenital anomti1U;

760-779, Ceti”ain causes of perinatal morbidity and mo~alit~.

3Blank diagnosis; noncodable diagnosis; illegible diagnosis.

17
Table9. Number, percent distribution, and cumulative percent of office visits made by children and young adults, bythe54 most

common physician diagnoses: United States, 1975

Principal diagnosis and lCDAcodel

1.

2<

3.

4.

5,

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

17.

18.

19.

20.

21.

22.

23.

24.

25.

26.

27.

28.

29.

30.

31.

32.

33.

34.

35.

36.

37.

38.

39.

40.

41.

42.

43.

44.

45.

46.

47.

48.

49.

50.

51.

52.

53.

54.

55.

All visits ................................................................................ ....................... ......................... ..

Medical or special examination .............................. .. ................ ................................................. Yoo

Acute upper respiratory infaction .............................................................................................465

Otitis media ..... ................ ................ .......... ........ ........................................................................38l

prenatal care ...................................................... ...... .........................................m.......................YO6

Medical and surgical aftercere ..................... ...... .. .............................................. .............. ..........Ylo

Acute pharyngitis .......................................................................................................................462

Acute tonsillitis .......................... ...... ........ ........................................................ ..........................463

Other eczema and dermatitis ......................................................................................................692

Bronchitis, unqualified .......................................................................................... ................... ..49O

Hay fever .................................... ............................................................................................... 507

Diseases of sabaceous glands ............................................... .......................................................7O6

Other viral diseases ................ .....................................................................................................o79

Inoculation and vaccination .............................................. ....................................................... . Y02

Refractive errors ........................................................................................................................37O

Observation, without need for further medical mre .................................. .......... .......................793

Asthma ............................................................................................................... .......................493

Streptococcal sore throat and scarlet fever

Diarrheal disease

........... ............................... .......................................o34

........................................................................................... ...... .......... .............om

Influenza, unqualified ................................................................. .. ............................................t47O

Cystitis .......................................................................................................................................595

Neuroses ....................................................................................................................................3oo

Otitis externa ................. ...................................... ......................................................................380

Hypertrophy of tonsils and adenoids ........................... ........................ ................ ......................5oo

Obesity ........................... .............................. ...................................................... .......................277

Acute nasopharyngitis (common cold) . ................................................ .. .............. ......................WO

Chronic sinusitis .................................................................... ........ ................................ .............5o3

Disorders of menstruation .............................. ................................ ........ ........................ ............626

Other and unspecified laceration of head ................................. ...................................... ............873

Acute bronchitis and bronchiolitis ................................... ........ ............................ ......................466

Other ill-defined and unknown causes of morbidity and mortality ............................................796

Other diseases of ear and mastoid process ................................ ..................................................387

Other person without complaint or illness................................................................................YO9

Pneumonia, unspecified ..................... ............................................................... ....................... ..~6

Acute laryngitis and tracheitis ........................................... .........................................................464

Infective diseases of uterus (excapt cervix), vagina, and vulva ................... .................................622

Postpartum observation ............................................................................................................YO7

Conjunctivitis and ophthalmia .................................................................. .................................36O

Impetigo ............................................................................................................ ........................684

Sprains and strains of other and unspecified parts of back ... ..................... ........ .. .......................847

Synovitis, bursitis, and tenosynovitis ...........! ...................................................... ...... .................73l

Symptoms referable to abdomen and lower gastrointestinal tract ............................ ..................785

Other diseases of urinary tract ............................................ .......................................................599

Other diseases of upper respiratory tract ............................ ........................ ...................... .. ........5O6

Special symptoms not elsewhere classified ................ ........................ .........................................3O6

Other general symptoms ............................................ ........................ ........ .. ........ ........ .......m......788

Infectious mononucleosis ...... .............................. ......................................... ..............................O75

Sprains and strains of ankle and foot ......................... .................................. ............... ...............845

Chronic pharyngitis and nasopharyngitis ...................................................................................5O2

Transient situational disturbances ................................ ............................................ ..................3o7

Behavior disorders of childhood .................... ....................... ......................................................3O8

Strabismus ........................... ........ ........................................ ......................................................373

Gastritis and duodenitis .............................................................................................................535

Other deformities . ...................................................... .. ............................................ ..................738

Symptoms referable to respiratory system ..... .... .. ........ ............................ .......... ............. ...........783

All other ...................................................................... ...... .............. ........ ........................................

Number

of visits

in thousands

157,431

23,457

8,220

7,597

6,050

5,867

4,597

4,543

4,158

3,260

2,968

2,894

2,620

2,611

2,459

2,022

1,753

1,706

1,494

1,411

1,1 B7

1,184

1,127

1,089

1,028

1,015

985

985

975

973

912

8B3

871

870

804

795

794

788

657

625

623

622

611

593

587

587

562

581

566

545

545

522

519

514

502

40,678

Percent

distribution

of visits

100.0

14.9

5.2

4.8

3.8

3.7

2.9

2.9

2.6

2.1

1.9

1.B

1.7

1.7

1,6

1,3

1.1

1.1

0.9

0.9

0.8

0.8

0.7

0.7

0.7

0.6

0.6

0,6

0.6

0.6

0.6

0.6

0.6

0.6

0.5

0.5

0.5

0.5

0,4

0.4

0.4

0.4

0.4

0.4

0.4

0.4

0.4

0.4

0.4

0.3

0.3

0.3

0.3

0.3

0.3

25.8

Cumulative

percent

100.0

14.9

20.1

24.9

28.7

32.4

35.3

3B.2

40.8

42.9

44.8

46.6

48.3

50.0

51.6

52.9

54.0

55.1

56.0

56.9

57.7

58.5

59.2

59.9

60.6

61.2

61.8

62.4

63.0

63,6

64.2

64.8

65.4

66.0

66.5

67.0

67.5

68,0

66.4

6B.8

69.2

68.6

70.0

70.4

70.8

71.2

71.6

72.0

72.4

72.7

73.0

73.3

73.6

73.9

74.2

100.0

lBa5ed on E@th Revision Intermtjoml Chssiflcats”onof Diseases, Adapted for Use in the united State.% 1965 (If~DA) (see

reference6).

18
Table IO. Numbarof office visits and visit rates forselected diagnoses for children and young adults, byaga of patient: United States,

1975

Principal diagnosis, ICDA code,l and age of patient

Medical or special examination (YOO)

Undar 2 yaars ........................................................................... .......................................................................

6-14 years ... ...... .. .................................................. ...... .....................................................................................

15-21 years ............................. ........ ...................... ...... .. ............................... ... .................................................

Acuta upper respiratory infection (465)

Under 2 years .............................................................................................................. ....................................

2-5 years ..................... .................... ................................................. ............... ..... ............................................

6-14 years .................. .............. .................................................. .................................. ....................................

15-21 ymrs ........................................................... ...........................................................................................

Otitis media (381)

Under 2 years ..................... .... .......... .............. .................................................................... .............................

2-5 years ........................... ........ ...... .. .................... ...................... .....................................................................

6-14 yaars .................. .. ........................................................................... ......... ....... .........................................

15-21 yaars ......................................................................................................................................................

Medical and surgical eftercare (YIO)

Under 2 years ..................... ..................................................................... ............................ ...........................

6-14 yaars ............. .................................. .........................................................................................................

15-21 years ......................................................................................................................................................

Acute pharyngitis (462)

Under 2 yeaE ............. ............ .......... .................................................. .............................................................

2-5 years .......................... ................. ....... .................................. ...................... ....... .........................................

6-14 years .................................. .......................................... ............ ...................... ...... ............ ........................

15-21 years ........ .................. .............. ...... ...................... ......................................... .........................................

Acute tonsillitis (463)

Under 2 yaam ............................................................................. .....................................................................

2-5 years ............................ .. ............................................................................................................................

6-14 years ........................................................................................................................................................

15-21 years ................................................................................................................................. .....................

Other eczema and dermatitis (692)

Under 2 years .................. ............................................................................ ....................................................

2-5 years ..................................................................... ...... .......................... ................ .....................................

15-21- years . ................................................................ .................... ............................ .....................................

Bronchitis, unqualified (490)

Under 2 years ..................................................................... .................... .........................................................

2-5 yearn .......................................... ............ ....................................................................................................

6-14 years .................................................... ............................ ............................ .................................... ........

15-21 years ... ........ .............. ...... .................................. ...................... .............. .................................................

Number of

visits in

thousands

9,174

3,914

4,738

5,631

2,003

2,384

2,156

1,679

1,860

2,796

2,335

●435

973

2,208

2,251

653

885

1,739

1,210

502

1,489

1,620

932

576

708

1,829

1,045

780

974

541

Number

of visits

par 1,000

per yearz

1,548

302

142

199

338

184

65

59

314

215

70

21

73

75

66

80

110

77

52

43

85

115

49

33

97

55

55

37

132

76

29

19

See footnotes at end of table.

19
Table 10. Number of office visits and visit rates for selected diagnoses for children and young adults, by age of patient: United States,

1975–Con,

.—-—

Principal diagnosis, ICDA code,l and age of patient

Hay fever (507)

Under 2 years ................................. .................... .. ...... ................ ............................................... .. ....................

2-5 years ...................................................... ................. ........ ........ ........ ................................. ..........................

6-14 years .............................................................................. ................................................ .............. ............

15-21 years .................. ................................................ .............................................................. ......................

Other viral diseases (079)

Under 2 years .......................................<c............... .. ........................................................................................

6-14 years ....................... ........................................................ .............. .. ................................. ........................

15-21 years ................................................................................................................................ ......................

Inoculation and vaccination (Y02)

Under 2 years ................. ..................................... ........................................ ......... ......................... ..................

2-5 years ............................... .......... ...... .......... .............................. .. ................................................... ..............

6-14 years ....... ................ ........ ........ ...... .. ........ ....................................... ..................... ............. ........................

15-21 years .................................................................................................................. .............. ......................

Asthma (493)

Under 2 years .......................... ........................ ........................................................................................... .....

2-5 years .......... ................................ ........ ........................................ ...................................... ..........................

6-14 years ................. ...... ........ ........ .. ...................... ................................................................. ........................

15-21 years .............................. .. ........ ........ ........ ...... ........ ....................................... ................................... ......

Number of

visits in

●139

● 355

1,579

895

● 288

*323

1,026

981

n 1

547

1,050

●303

● 236

*488

630

● 396

Number

a,f visits

per 1,000

parsons

per year2

——

23

27

47

32

49

25

31

35

120

42

31

11

40

38

19

14

1Baed OnEighthIntematjomz ch,r.sifica~.onof Diseases, Adapted for Use in the United States, 196-$ OCDA) (see reference @

z~ate~ are based on population estimates for JUIY 1, 1975, furnished by the U.S, Bureau of the Census (see appendix 1).

. .
APPENDIXES

CONTENTS

I. Te&tid Notes.................................................................................................................................

StatisticalDai~ ..........................................................................................................................

Data Collection and Prmcssbg .....................................................................................................

EstimationRocedwcs ..................................................................................................................

Reliability of Estimates................................................................................................................

Tests of ti@fi.m .......................................................................... ..........................................

PopulationFi~s ........................................................................................................................

systematic Bm ........................................................................................a...................................

IL Defition of Cefi Terns Usedinfi Repoti...............................................................................

‘1’crrns Relatingto the Survey.......................................................................................................

Terms Relatingto the PatientRecord Fom .................................................................................

III. Survey Instruments ...................................................................... ......................................................

Introductory LetterFrom Director,NationalCenterfor HealthStatistics....................................

PatientRecord andPatientLog....................................................................................................

Induction InterviewFom ............................................................................... ....................... ....

22

22

23

:

28

28

28

30

30

31

33

33

E

LIST OF APPENDIX FIGURES

I. Approximate relativestandarderrors for estimatednumbers of office vMts, 1975 NationalAmbulatory Medical Care Survey .............................................................................................................. 26

IL Approximate relative standarderrors for pcmentagcs of estimatednurnbcrsof office vMts, 1975

NationalAmbulatoryMedicalCareSurvey...................................................................................... 27

LIST OF APPENDIX TABLES

L Dutribution of physicians in the universe (American Medical Association and American Osteopathic Association) and in the National Ambulatory Medical Survey sample,by physician’s specialty: UnitedStates,J&rmary-December1975................................................................................ 23

IL Estimatesof the civilian noninstitutiomidizcdpopulation of the United States, by age, SCX,and

racc,Joly 1, 1975................................................................................................. .......................... 29

21
APPENDIX 1

TECHNICAL NOTES

Statistical Design

Scope of the survey. –The target population

of the National Ambulatory Medical Care Survey (NAMCS) encompasses office visits within

the coterminous United States made by ambulatory patients to nonfederally employed physicians who are principally engaged in office

practice, but not in the specialties of anesthesiology, pathology, and radiology. Telephone contacts and nonoffice visits are excluded.

Sampling frame and sample size. –The sampling frame for the NAMCS is composed of all

physicians contained in the master files maintained by the American Medical Association

(AMA) and American Osteopathic Association

(AOA) as of December 31, 1974, who met the

following criteria:

Office-based, as defined by the AMA and

AOA.

Principally engaged in patient care activities.

Nonfederally employed,

Not in the specialties of anesthesiology,

pathology, clinical pathology, forensic pathology, radiology, diagnostic radiology,

pediatric radiology, or therapeutic radiology.

The 1975 physician universe included

180,125 doctors of medicine and 9,696 doctors

of osteopathy.

The 1975 NAMCS sample included 3,507

physicians. Sample physicians were screened at

the time of the survey to assure that they met

the above-mentioned criteria; 438 physicians did

not meet all of the criteria and were, therefore,

ruled out of scope (ineligible) for the study.

The most frequent reasons for being out of

scope were that the physician was retired,

deceased, or employed in teaching, research, or

administration. Of the 3,069 in-s~ope (eligible)

physicians, 2,472 (80.5 percent) participated in

the study. The physician universe, sample size,

and response rates by physician specialty are

shown in table I. Of the participating physicians,

391 physicians saw no patients during their

assigned reporting period because of vacations,

illness, or other reasons for being temporarily

not in practice.

SaGpk design. –The 1975 NAMCS utilized a

multistage probability design that involved probability samples of primary sampling units

(PSU’S), physician practices within PSLJ’S, and

patient visits within practices. The first-stage

sample of 87 PSU’S was selected by the National

Opinion Research Center, the organization

responsible for field operations under contract to the National Center for Health Statistics

(NCHS). A PSU is a county, a group of adjacent

counties, or a standard metropolitan statistical

area (SMSA). A modified probabilityproportional-to-size procedure using separate

sampling frames for SMSA’S and for nonmetropolitan counties was employed. After sorting

and stratifying by size, region, and demographic

characteristics, each frame was divided into

sequential zones of 1 million residents, and a

random number was drawn to determine which

PSU came into the sample from each zone.

The second stage consisted of a probability

sample of practicing physicians selecte(d from

the Master Physician files maintained by

the AMA ~d AOA. Within each PSU, all

eligible physicians were arranged by nine specialty groups: general and family practice,

internal medicine, pediatrics, other medical specialties, general surgery, obstetrics and gynecology, other surgical specialties, psychiatry, and

other specialties. Then, within each PSU, a

22
Tabla 1. Distribution of physicians in the universa (American Medical Association and American Osteopathic Association) and in the

National Ambulatory Medical Care Survey sample, by physician’s specialty: United States, January-December 1975

Physician’s specialty

All specialties ....................................... ...........................

General and family pr=tim .............................................

Medical s~cialties ...........................................................

Internal medicine ............................................................................

Pediatrics ...................................................................................... ...

Other medical swcialties ..... ............................................................

Surgical s~cialties ...........................................................

General surgery ............................................................ ...................

Obstetrics and gyn=oiqy ...............................................................

Other surgical specialties ......................... ....................... .................

Other swcialties ..............................................................

Psychiatry ........................... ......................................................... ...

Other s~cialties .................. ............................................................

I I I 1 I 1

Number of physicians

3,069 597 2,472 80.5

789 179 610 77.3

49,801 942

F

121

59

39

23

89

22

25

42

106

821

446

200

175

1,166

165

99

28

38

214

656

347

172

137

952

79.9

77.8

86.0

78.3

81.6

26,125

12,228

11,447

505

239

198

65,434 1,255

19,606

15,124

30,704

371

311

573

349

286

531

293

63

53

98

39

286

233

433

254

81.9

81.5

81.5

21,517 388 86.7

210

83

20

19

190

64

90.5

77.1

systematic random sample of physicians was

selected in such a way that theoverall probability of selecting any physician in the United

States was approximately constant.

The final stage was the selection of patient

visits within the annual practices of sample

physicians. This involved two steps. First, the

total physician sample was divided into 52

random subsamples of approximately equal size,

and each subsample was randomly assigned to 1

of the 52 weeks in the survey year. Second, a

systematic random sample of visits was selected

by the physician during the assigned week. The

sampling rate varied for this final step from a

100-percent sample for very small practices to a

20-percent sample for very large practices as

determined in a presurvey interview. The

method by which the sampling rate was determined is described in the Induction Interview

form displayed in appendix III.

Data Collection and Processing

Field procedures. –Both mail and telephone

contacts were used to enlist sample physicians

into the NAMCS. Physicians received introductory letters from the NCHS (see appendix III)

and the AMA or AOA. When appropriate, a

letter from the physician’s specialty organization, endorsing the survey and urging his participation, was enclosed with the NCHS letter. A

few days later, a field representative telephoned

the sample physician to briefly explain the study

and arrange an appointment for a personal

interview. An initially nonresponding physician

was generally recontacted via a telephone call or

special explanatory letter and requested to

reconsider participation in the study.

During the personal interview, the field representative determined the sample physician’s

eligibility, ascertained his cooperation, delivered

survey materials with verbal and printed instructions, and assigned a predetermined Monday

through Sunday reporting period. A short interview concerning basic practice characteristics,

such as type of practice and expected number of

office visits, was administered. Office staff who

were to assist with data collection were invited

to attend the instruction session or were offered

separate instruction sessions.

23
Before the beginning of and again during the

week assigned for data collection, the interviewer telephoned the sample physician to answer possible questions and to insure that

procedures were going smoothly. At the end of

the survey week, the participating physician

mailed finished survey materiaIs to the interviewer who edited the forms for completeness

before transmitting them for central data processing. Problems or missing data at this stage were

resolved by interviewer telephone followup to

the sample physician; if there were no problems,

field procedures were complete with respect to

the sample physician’s participation in the

NAMCS. After the end of the survey year each

sample physician was sent a thank-you letter

from the NCHS along with one of the survey’s

statistical reports.

Data collection. –The actual data collection

for the NAMCS was carried out by the physician

aided by his office staff when possible. Two data

collection forms were employed by the physician: the Patient Log and the Patient Record

(appendix III). The Patient Log is a sequential

listing of patients seen in the physician’s office

during his assigned reporting week. This list

served as the sampling frame to indicate the visit

for which data were to be recorded. A perforation between the patient names and patient visit

characteristics permitted the physician to remove patient names and protect confidentiality.

Based on the physician’s estimate of the

expected number of office visits, each physician

was assigned a patient sampling ratio. These

ratios were designed so that about 30 Patient

Records were completed during the assigned

reporting week. Physicians expecting 10 or

fewer visits each day recorded data for all of

them, while those expecting more than 10 visits

per day recorded data for every second, third, or

fifth visit, based on the predetermined sampling

interval. These procedures minimized the data

collection workload and maintained approximate equal reporting levels among sample physicians regardless of practice size. For physicians

assigned a patient sampling ratio, a random start

was provided on the first page of the Iog, so that

predesignated sample visits on each succeeding

page of the log provided a systematic random

sample of patient visits during the reporting

period.

Data processing. –In addition to completeness checks made by the field staff, clerical edits

were performed upon receipt of the data for

central processing. These procedures proved

quite efficient, reducing the item nonnesponse

rates to a negligible amount-2 percent or less

for all data items.

Information contained in item 5 (patient’s

problem) of the Patient Record was coded

according to a special classification system developed for that purposes Diagnostic information,

item 9 of the Patient Record, was coded

according to the Eighth Revision International

Classification of Diseases, Adapted for Use in

the United States(ICDA).4 A maximum of three

problems and three diagnoses were coded. A

two-way independent verification procedure

with 100-percent verification was used to control the medical coding operation. Differences

between coders were adjudicated at the National

Center for Health Statistics.

Information from the Induction Interview

and Patient Record was keypunched, with 100-

percent verification, and converted to computer

tape. At this time, extensive computer consistency and edit checks were performed. Data

items still unanswered at this point were imputed by assigning a value from a Patient Record

with similar characteristics; imputations were

based on physician specialty, major reason for

visit, and broad diagnostic categories.

Estimation Procedures

Statistics produced from the 1975 NAMCS

were derived by a multistage estimating procedure. The procedure produces essentially unbiased national estimates and has basically three

components: (1) inflation by reciprocals of the

probabilities of selection, (2) adjustment for

nonresponse, and (3) a ratio adjustment tlo fixed

totals. Each of these components is described

briefly below.

Injlation by reciprocals of sampling probabilities. —Because the survey utilized a threestage sample design, there were three prcJbabilities: (1) the probability y of selecting the PSU,

(2) the probability of selecting a physician within

the PSU, and (3) the probability of selecting a

patient visit with _the physician’s practice. The

last probability was defined to be the exact

24
number of office visits during the physician’s

specified reporting week divided by the number

of Patient Records completed. All weekly estimates were inflated by a factor of 52 to derive

annual estimates.

Adjustment for nonresponse. —Estimates

from the NAMCS data were adjusted to account

for sample physicians who did not participate in

the study. This was done in such a manner as to

minimize the impact of nonresponse on final

estimates by imputing to nonresponding physicians the practice characteristics of similar responding physicians. For this purpose, similar

physicians were judged to be physicians having

the same specialty designation and practicing in

the same PSU.

Ratio adjustment. –A poststratification adjustment was made within each of nine physician specialty groups. The ratio adjustment was

a multiplication factor which had as its numerator the number of physicians in the universe in

each physician specialty group, and as its denominator the estimated number of physicians

in that particular speciaIty group. The numerator was based on figures obtained from the

AMA-AOA Master Physician files, and the denominator was based on data from the sample.

Reliability of Estimates

Since the statistics presented in this report

are based on a sample, they will differ somewhat

from the figures that would be obtained if a

complete census had been taken using the same

forms, instructions, and procedures. However,

the probability design of the NAMCS permits

the calculation of sampling errors. The standard

error is primarily a measure of sampling variability that occurs by chance because only a sample

rather than the entire population is surveyed. As

calculated in this report, the standard error ZLIso

reflects part of the! variation that arises Iin the

measurement process. It does not include estimates of any systematic biases that may be in

the data. The chances are about 68 out of 100

that an estimate from the sample would differ

from a complete census by less than the standard error. The chances are about 95 out of 100

that the difference would be less than twice the

standard error and about 99 out of 100 that it

would be less than 2Y2 times as large.

The relative standard error of an estimate is

obtained by dividing the standard by the estimate itself and is expressed as a percentage of

the estimate. For this report, asterisks (*) are

presented along with the estimate for any

estimate with more than a 3 O-percent relative

standard error.

Estimates of sampling variability were calculated using the method of half-sample replication. This method yields overall variability

through observation of variability among random subsamples of the total sample. A description of the development and evaluation of the

replication technique for error estimation has

been previously pubIished.7 ~s

Approximate relatwe standard errors for

aggregates and percentages are presented in

figures I and II. In order to derive error

estimates that would be applicable to a wide

variety of statistics and that could be prepared

at moderate cost, several approximations were

required. As a result, the relative standard errors

shown in figures I and II should be interpreted

as approximate rather than exact for any specific estimate. Directions for determining approximate relative standard errors from the figures

follow.

1.

.

Estimates of aggregates: Approximate

relative standard errors (in percent) for

aggregate statistics, such as the number

of office visits with a given characteristic, are obttined from the curve in figure

I, or calculated by the formula

001160252 + 44”6;97 - 100

2.

where x is the aggregate of interest in

thousands.

Estimates of percentages: Approximate

relative standard errors (in percent) for

estimates of this type can be calculated

from the curve in figure I as follows.

Obtain the relative standard error of the

numerator and denominator. Square

each of the relative standard errors,

subtract the resulting value for the

denominator from the resulting value for

NOTE: A list of references follows the text.

25
7

Q

z

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1111 .3

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n

0

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(lN33kJ3d Nl) LIOUU3 CIWCINVIS 3A11V73U

26
Figure 11. Amxoxirnate relative standard errors for percentages of estimated numbers of office visits,

1975 National Ambulatory Medical Care Survey

. .

100

90

80

70

60

50

40

30

K;

o

K4

K

W3

n

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a2

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45

(Base of percentage shown on curves in millions)

[ I 1 1-1-111111 I 1 I 1 I 1 1 1 1

i

[ 1

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6789A 2 34 56789A

A A

10 100

ESTIMATED PERCENTAGE

%

80

70

- 60

- 50

- 40

- 30

- 20

- - ‘6

- 5

- 4

3

- 2

- .5

- .4

- .3

- .2

— .1

Example of use of this chart: An estimate of 20 percent (read at bottom of chart) based on an

estimate of 10 million office visits has a relative standard error of 13.4 percent (read from scale at left

of chart) or a standard error of 2.7 percentage points (13.4 percent of 20 percent).

27
the numerator, and extract the square

root. This calculation has been made for

several percentages and bases and is

presented in figure II. Alternatively, the

formula

‘sE@)=rTT-” ’00

can be used to calculate RSE for any

percentage (p) and base (x, in thousands).

3. Estimates of rates where the numerator

is not a subclass of the denominator:

Approximate relative standard errors for

rates where the denominator is the total

U.S. population or one or more of the

age-sex-race groups of the total population are equivalent to the relative standard error of the numerator that can be

obtained from figure I.

4. Estimates of differences between two

statistics: The relative standard errors

shown in this appendix are not directly

applicable to differences between two

sample estimates. The standard error of a

difference is approximately the square

root of the sum of the squares of each

standard error considered separately.

This formula will represent the standard

error quite accurately for the difference

between separate and uncorrelated

characteristics, although it is only a

rough approximation in most other

cases.

In addition to sampling error, survey results

are subject to reporting and processing errors

and biases due to nonresponse or incomplete

response. There is no way to compute the

magnitude of these errors. How-ever, these types

of errors were kept to a minimum by methods

built into the survey procedures. Extensive

pretesting was done and careful attention was

given to phrasing of the questions and the terms

employed and their definitions in order to eliminate ambiguities and encourage uniformity.

Steps taken to reduce nonresponse bias are

discussed in the sections on field procedures and

data collection. Errors in coding and processing

were reduced by verification and consistency

checks.

Tests of Significance

In this report, the determination of statistical

inference is based on the t-test with a critical

value of 1.96 (0.05 level of significance). Terms

relating to differences, such as “higher,” “’less,”

etc., indicate that the differences were statistically significant. Terms such as “similar,” “no

difference,’’etc., mean that no statistical significance exists between the statistics being compared. Lack of comment regarding the difference between any two statistics does not mean

the difference was tested and found to be not

significant.

Population Figures

The base population used in computing

annual visit rates is presented in table II. These

figures are based on provisional estimates for the

civilian noninstitutionalized population as of

July 1, 1975, provided by the U.S. Bureau of

the Census. Because the NAMCS includes data

for only the coterminous United States, the

original census estimates were modified to

account for the exclusion of Alaska and H[awaii

from the study. For this reason the population

estimates should not be considered as official

population estimates and are presented here

solely for the purpose of providing denominators for rate computations.

Systematic Bias

There have been no attempts to determine

systematic bias in the data reported here or to

measure the impact of any biases. There are

several factors, however, that the user of these

data should understand, all of which indicate

that these data underrepresent the total number

of office visits to office-based physicians. These

factors are:

1. The sampling universe for the 1975

NAMCS was the files of “office-b,ased,

patient-care” physicians maintained by

the AMA and AOA. There are certainly

physicians not so classified who, ak the

time of the survey, would have met the

28
Table Il. Estimates of the civilian noninstitutionalized population of the United States,l by age, sex, and race, July 1,1975

[Used in the calculation of rates]

Sex and race

Total ...........................................................................................................

—Sex

Female ........................................................................................................................

Male ............................................................................................................................

Race

All other .....................................................................................................................

1Excludes Alaska and Hawaii.

2.

Age

All Under 2-5 6-14 15-21

ages 2 years years yeare years

Numbers in thousands

80,556

39,614

40,942

67,733

12,823

5,928

2,900

3,028

4,907

1,021

12$76

6,350

6,626

10,748

2,228

33,401

16,376

17,025

28,030

5,371

28,251

13,988

14,263

24,048

4,203

criteria for that cl+sification. Visits to 3. Physicians who participated in the

these physicians are not represented in

these data.

A frequent reason for not participating

in the NAMCS was given as ~’too busy”

or “too busy right now.” This IS an

indication that the busier physician was

not as likeIy to participate as the less

busy physician.

NAMCS did a thorough- and conscientious job in keeping the Patient Log;

however, the probability that a patient

was accidentally omitted from the survey is much greater than the probability

that a patient was included who did not

make a visit. This factor could also

introduce a slight bias.

—000

28
APPENDIX II

‘DEFINITIONS OF CERTAIN TERMS USED IN THIS REPORT

Terms Relating to the Survey

Office(s). –Premises that the physician identifies as locations for his ambulatory practice.

Responsibility over time for patient care and

professional services rendered there generally

resides with the individual physician rather than

with any institution.

Ambulatory patient. –An individual presenting for personal health services, neither bedridden nor currently admitted to any health care

institution on the premises.

Physician. –Can be classified as either:

In-scope: All duly licensed doctors of medicine and doctors of osteopathy currently in

practice who spend some time in caring for

ambulatory patients at an office location.

Out-of-scope: Those physicians who treat

patients only indirectly, including specialists

in anesthesiology, pathology, forensic pathology, radiology, therapeutic radiology,

and diagnostic radiology, and the following

physicians:

Physicians in military service.

Physicians who treat patients only in an

institutional setting (e.g., patients in

nursing homes and hospitals).

Physicians employed full time by an

industry or institution and having no

private practice (e.g., physicians who

work for the Veterans Administration,

the Ford Motor Company, etc).

Physicians who spend no time seeing

ambulatory patients (e.g., physicians

who only teach, are engaged in research,

or are retired).

Patients. –Can be classified as either:

In-scope: All patients seen by the physician

or member of his staff in his office(s).

Out-of-scope: Patients seen by the physician

in a hospital, nursing home, or other extended care institution, or the patient’s

home. [Note: If the doctor has a private

office (which fits definition of “office”)

located in a hospital, the am,bulat,ory patients seen there would be considered inscope. ] The following types of patients are

also considered out of scope:

Patients seen by the physician in any

institution (including outpatient clinics

of hospitals) for which the institution

has the primary responsibility for the

care of the patient over time.

Patients who telephone and receive ad.

vice from the physician.

Patients who come to the office only to

leave a specimen, pick up insurance

forms, or pay their bills.

Patients who come to the office only to

pick up medications previously prescribed by the physician.

Visit. –A direct, personal exchange between

ambulatory patient and the physician (or members of his staff) for the purpose of seeking care

and rendering health services.

Physician specialty. –Principal specialty (in30
eluding general practice) as designated by the

physician at the time of the survey. Those

physicians for whom a specialty was not obtained were assigned the principal specialty

recorded in the Master Physician files maintained by the AMA or AOA.

Region of practice location.–The four geographic regions, excluding Alaska and Hawaii,

which correspond to those used by the U.S.

Bureau of the Census, are as follows:

Regz”on

Northeast . . . . . . .

North Central . . .

South . . . . . . . . . . .

West . . . . . . . . . . . .

States included

Connecticut, Maine, Massachusetts, New Hampshire,

New Jersey, New York,

Pennsylvania, Rhode Island,

Vermont

Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota,

Missouri, Nebraska, North

Dakota, Ohio, South

Dakota, Wisconsin

Alabama, Arkansas, Delaware, District of Columbia,

Florida, Georgia, Kentucky,

Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia,

West Virginia

Arizona, California, Colorado, Idaho, Montana, Nevada, New Mexico, Oregon,

Utah, Washington, Wyoming

Metropolitan status of practice location. –

Physician’s practice is classified by its location in

metropolitan or nonmetropolitan areas. Metropolitan areas are standard metropolitan statistical areas (SMSA’S) as defined by the U.S.

Office of Management and Budget.

The definition of an individual SMSA involves two considerations: first, a city or cities

of specified population that constitute the

central city and identify the county in which it

is located as the central county; second, economic and social relationships with “contiguous” counties that” are metropolitan in

character, so that the periphery of the specific

metropolitan area may be determined. SMSA’S

may cross State lines. In New England SMSA’S

consist of cities and towns, rather than counties.

Terms Relating to the Patient Record Form

Age. –The age calculated from date of birth

was the age at Iast birthday on the date of visit.

Color or race. –On the Patient Record, color

or race includes four categories: white, Negro/

black, other, and unknown. The physician was

instructed to mark the category which in his

judgment was most appropriate for the patient

based upon observation and/or prior knowledge

of the patient. “Other” was restricted to Orientals, American Indians, and other races neither

Negro nor white.

Patient k principal problem(s), complaint(s),

or symptom(s) (in patient’s own words). —The

patient’s principal problem, complaint, symptom, or reason for the visit as expressed by the

patient. Physicians were instructed to record key

words or phrases verbatim to the extent possible, listing that problem first which in the

physician’s judgment was most responsible for

the patient’s visit.

Sen”ousness of problem in item 5a.–This

item includes four categories: very serious,

serious, slightly serious, and not serious. The

physician was instructed to check one of the

four categories according to his own evaluation

of the seriousness of the patient’s problem

causing this visit. Seriousness refers to physician’s clinical judgment as to the extent of

the patient’s impairment that might result if no

care were given.

Major reason(s) for this visit.–The patient’s

major reason(s) for the visit were classified by

the physician into one or more of the following

categories:

Acute problem: A condition or illness having

a relatively sudden or recent onset (i.e.,

within 3 months of the visit).

Acute problem, followup: A return visit

primarily for continued medical care of a

previously treated acute problem.

31
Chronic problem, routine: A visit primarily

to receive regular care or examination for a

preexisting chronic condition or illness (onset of condition was 3 months or more

before this visit).

Chronic problem, jlareup: A visit primarily

due to a sudden exacerbation of a preexisting chronic condition.

Prenatal care: Routine obstetrical care provided prior to delivery.

Postnatal care: Routine obstetrical care or

examination provided following delivery or

termination of pregnancy.

Postoperative care: A visit primarily for care

required following surgical treatment. Includes changing dressing, removing sutures

or cast, advising on restriction of activities or

routine after surgery checkup.

Well adult/child exam: General health maintenance examinations and routine maintenance examinations and routine periodic

examinations of presumably healthy persons, both children and adults. Includes

annual physical examinations, well-child

checkups, school, camp, and insurance examinations.

Family planning: Services or advice that

enable patients to determine the number and

spacing of their children. Includes both

contraception and infertility services.

Counseling/advice: Information of a health

nature which would enable the patient to

maintain or improve his physical or mental

well-being. Included would be advice regarding diet, changing habits or behavior, and

general information regarding a specific

problem.

Immunization: Administration of any inoculation of specific substances to produce a

desired immunity; this includes oral vaccines. (Allergy shots are not included in this

category, but are entered in “other.”)

Referred by another physician/agency:

Medical attention prompted by advice or

referral for consultation or treatment from

another physician, hospital, clinic, health

center, school nurse, minister, pharmacist,

etc. Does not include self-referral or referral

by family or friends.

Administrative purpose: Reasons such as

completing insurance forms, school forms,

work permits, or discussion of patient’s bill.

Other: The reason for this visit is not

covered in the preceding list.

Principal dia~osis. –The physician’s dia@osis of the patient’s principal problem or complaint. In the event of multiple diagnoses, the

physician was instructed to list them in order of

decreasing importance; “principal” refers to the

first-listed diagnosis. The diagnosis represents

the physician’s best judgment at the time of the

visit and may be tentative, provisional, or

definitive.

Other significant current diagnosis. –The diagnosis of any other condition known to exist

for the patient at the time of the visit. Other

diagnoses may or may not be related to the

reason for that visit.

Treatments and services ordered or provided. —These include the following:

Limited history/exam: History and/or physical examination which is limited to a specific

body site or system, or which is concerned

primarily with the patient’s chief complaint,

for example, pelvic exam or eye exam.

Generai history/exam: History and/or physical examination of a comprehensive nature,

including all or most body systems.

Clinical lab test: One or more laboratory

procedures or tests including examination of

blood, urine, sputum, smears, exudates,

transudates, feces, and gastric content, and

including chemistry, serology, bacteriology,

and pregnancy test.

Blood pressure check: Self-explana~tory.

EKG: Electrocardiogram.

Hean”ng test: Auditory acuity test.

Vision test: Visual acuity test.

Endoscopy: Examination of the interior of

any body cavity, except ear, :nose, and

throat, by means of an endoscope.

Office surgery: Any surgical procedure performed in the office this visit, including

32
suture of wounds, reduction of fractures,

application/removal of casts, incision and

draining of abscesses, application of supportive materials for fractures and sprains, and

all irrigations, aspirations, dilatations, and

excisions.

Drug prescribed: Drugs, vitamins, hormones,

ointments, suppositories, or other medications ordered or provided, except injections

and immunizations.

X-ray: Any single or multiple X-ray examination for diagnostic or screening purposes.

Radiation therapy is not included in this

category.

Injection: Administration of any substance

by syringe and needle subcutaneously, intravenously, or intramuscularly. This category

does not include immunizations, enemas, or

douches.

Immunization/desensitization: Administration of any immunizing, vaccinating, or desensitizing agent or substance by any route,

for example, syringe, needle, orally, gun, or

scarification.

Physiotherapy: Any form of physical th;rapy ordered or provided, including any

treatment using heat, light, sound, or physical pressure or movement, for example,

ultrasonic, ultraviolet, infrared, whirlpool,

diathermy, cold therapy, and manipulative

therapy.

Medical counseling: Instructions and recommendations regarding any health problem,

including advice or counsel about diet,

change of habit, or behavior. Physicians are

instructed to check this category only if the

medical counseling is a si~ificant part of the

treatment.

Psycho therapy/therapeutic listening: AU

treatments designed to produce a mental or

emotional response through suggestion, persuasion, reeducation, reassurance, or support, including psychological counseling,

hypnosis, psychoanalysis, and transactional

therapy.

Other: Treatments or services rendered

which are not listed in the preceding categories.

Disposition. –Eight categories are provided

to describe the physician’s disposition of the

case as follows:

No fo[lowup planned: No return visit or

telephone contact was scheduled for the

patient’s problem on this visit.

Return at specified time: The patient was

told to schedule an appointment or was

instructed to return at a particular time.

Return if needed, P. R.N.: No future appointment was made, but the patient was

instructed to make an appointment with the

physician if the patient considers it necessary.

Telephone followup planned: The patient

was instructed to telephone the physician on

a particular day to report on his progress, or

if the need arises.

Referred to other physician/agency: The

patient was instructed to consult or seek

care from another physician or agency. The

patient may or may not return to this

physician at a later date.

Returned to refem”ng physician: Patient was

referred to this physician and was now

instructed to consult again with the physician or agency which referred him.

Admit to hospital: Patient was instructed

that further care or treatment will be provided in a hospital. No further office visits

were expected prior to that admission.

Other: Any other disposition of the case not

included in the above categories.

Duration of visit. –Time the physician spent

with the patient, but does not include the time

patient spent waiting to see the physician, time

patient spent receiving care from someone other

than the doctor without the presence of the

physician, and time spent reviewing records,

tests results, and so forth. In the event a patient

was provided care by a member of physician’s

staff but did not see the physician during the

visit, “duration of visit” was recorded as zero

minutes.

33
APPENDIX Ill

SURVEY INSTRUMENTS

INTRODUCTORY LETTER FROM DIRECTOR,

NATIONAL CENTER FOR HEALTH STATISTICS

DEPARTMENT OF HEALTH. EDUCATION, AND WELFARE

PUBLIC HEALTH SERVICE

MEALTH RESOURCES ADMINISTRATION

WKVILLE. MARVLAND -

NATIO+AALCENTER FOR

HE4LTH STATISTICS

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Ammk.* madomy of PUlatrks

RobuI G. Frazier, M.O.

Exuutlv* CUmctor

Am9tlcaII C911W 01 0b11@8tam

●e aYl190910sNh

wwmn H. krw, M.D.

Otmctor

Am@rlem! CO1lW of ●BYdstam

Edwwa C. Ros9n0w, Jr., M.O.

ExDcutlvO WC* PN81d8nt

Awm”d;;c*t9s9 Ofn’wMuWmd Smtlay

Ex=UtlW OlmCtOr

AIIIUICQ.C011CS901 SIIWUIW

C. Rolllns hanlon. M.D.

mmcutlw Dwutor

Anlm’N,” OltWN~WC AUWIO@O.

Wward P. Crowwll. 0.0.

EXUU: IV* Dmctor

Am99tc1n ●rOetOleCIc SMhtY

AWmdra F. Utro, M.D.

Surotaw

Anmrlmn PsYctllWU4 AUUbtt*n

M#lvl. Szbutln. M.D.

M9elcal Dlrutor

Am9rlcM S8CI.W 01 trJ8*rml

MMICIM

Wllllim R. RmIWW

Ex9cutlv# Dlractor

Am9F10m SSClatY 01 PIM188M R*COIWWUMIW Sursoons,Inc.

0s11,s F. WhalW

Exuutlw VICO Pmddwt

Dear Dr,

The National Center for Health Statistics, as part of its

continuing program to provide information on the health

status of the American people, is conducting a National

Ambulatory Nedical Care Survey (NJN4CS).

The purpose of this survey la to collect information

about ambulatory patients, their problems, and the

resourcee used for their care. The result ing published

statistics will help your profession plan for more

effective health services, determine health manpower

requirements, and improve medical education.

Since practicing physicians are the only reliable source

of this information, we need your assistance in the NAMCS.

As one of the physicians selected in our national sample,

your participation is essential to the success of the

survey. Of course, all information that you provide Is

held in strict confidence.

Msny organizations and leaders in the medical profession

have expressed their support for this survey, including

those shown to the left. They join me in urging your

cooperation in this important research.

Within a few daya, a survey representative will telephone

you for an appointment to discuss the details of your

participation. We greatly appreciate your cooperation.

Sincerely yours,

Dorothy P. Rice

Director

AIM,Ic.” U,oleflc Ruu1.91e.

FM s. J.mlnw, Jr.. M.D.

ExUUtlV9 Dtr9ct01

A:$u)c:I,oII of Amdc,II MAuI

Jolt.A,0. COW-. M.D., PII.D.

FWilmnt
m

—

35
INDUCTION INTERVIEW FORM

CONFIDENTIAL*

NORC-4211

NATIONAL

TIME AM

BEGAN: PM

EEEEzi;

AMBULATORY MEDICAL CARE SURVEY

INDUCTION INTERVIEW

m-

(Phys. ID Numb~~

I

BEFORE STARTING INTERVIEW

I

1. ENTER PHYSICIAN I.D. NUMBER IN BOX TO RIGHT, ABOVE I

2. ENTER DATES OF ASSIGNED REPORTING WEEK IN Q. 2, P.2

“Doctor, before I begin, let me take a minute to give you a little background

about this survey.

Although ambulatory medical care accounts for nearly 90 per cent of all medical

care received in the United States, there is no systematic information about

the characteristics and problems of people who consult physicians in their

offices. This kind of information has been badly needed by medical educators

and others concerned with the medical manpower situation.

In response to increasing.demands for.this kind of information, the National

Center for Health Statistics, in close consultation with representatives of the

medical profession, has developed the National Ambulatory Medical Care Survey.

Your own task in the survey is simple, carefully designed, and should not take

much of your time. Essentially, it consists of your participation during a

specified 7-day period. During this period, you simply check off a minimal

amount of information concerning some of the patients you see.

Now, before we get into the actual procedures, I have a few questions to ask

about your practice. The answers you give me will be used only for classification

and analysis, and of course —all information you provide %s held in strict confidence.*

1. First, you are a Ia that right?

(ENTER SPECIALTY FROM CODE ON FACE SHRET LABEL.)”

Yes 1

No I ~&K”Aj I I 2

A. IF NO: What is your specialty, (including general practice)?

—

(Name of Specialty)

*All information which would permit identification of an individual, a

practice, or an establishment will be held confidential, will be used only by

persons engaged in and for the purpose of the survey, and will not be disclosed

or released to other persons or used for any other purpose.

36
-.> NOW, doctor,

you will see

BELOW .)

-2-

this study will be concerned with

in your office during the week of

the ambulatory patients

(READ REPORTING DATES ENTERED

(that’s a (that’s a

I Monday) through f Sunday)

month date month date

Are you likely to see ~ ambulatory patients in your office during

Yes . . . (GOTOQ. 3) .

No . . . . . (ASK A) .

A. IF NO: Why is that? RECORD VERBATIM, TREN READ PAMGRAPH BELW

that week?

. . 1

. . 2

Since It’s very important, doctor, that we include any ambulatory

patients that you do happen to see in your office during that

week, I’d like to=ave these forms with you anyway--just in case

your plans change. I’ll plan to check back with your office just

before (STARTING DATE) to make sure, and I can explain them in

detail then, if necessary.

GIVE D9CTOR THE ~ PATIENT RECORD FORMS AND GO TO Q. 9, p. 6.

37
3. A.

B.

c.

-3-

At what office location will you be seeing ambulatory patients during that

7-day period? RECORD UNDER A BELOW AND ASK B WHEN INDICATED.

IF HOSPITAL EMERGENCY ROOM OR HOSPITAL OUTPATIENT DEPARTMENT, OR OTHER

INSTITUTIONAL LOCATION IN A: Thinking about the ambulatory patients you see

in (PLACE IN A), do YOU, yourself, have principal responsibility for their

care over time, or does (INSTITUTION IN A) have primary responsibility for

their care over time? CODE UNDER B BELOW.

Is that Q of the office locations at which you expect to see ambulatory

patients during that week?

Yes. . . . . . . 1

No . . . . . . . 2

—.IF NO. OBTAIN ADDITIONAL OFFICE LOCATION(S), ENTER IN “A’’’BELOW,AND REPEAT.

A. B.

Principal

Office Location Responsibility?

(1) 1 2

(2) 1 2

(3)

1 2

(4)

1 2

~

D.

n Scope?

Yes No

12

12

12

12

D. FOR EACH OFFICE LOCATION ENTERED IN A, CODE YES OR NO TO “IN SCOPE’*AEOVE.

I IN SCOPE (Yes)] ]OUT OF SCOPE (No)

Private offices

Free-standing clinics

(non-hospital based)

Groups, partnerships

Kaiaer, HIP, Mayo Clinic

Neighborhood Health Centers

Privately operated clinics

(except family planning)

IN CASE OF DOUBT. ASK: Is that

Is that

Hospital emergency rooms

Hospital outpatient departments

College or university infirmaries

Industrial outpatient facilities

Family planning clinics

Government-operated clinics

(VD, maternal & child health, etc.)

(clinic/facility/institution) hospital based?

(clinic/facility/institution) government

operated?

IF ALL LOCATIONS ARE OUT OF SCOPE, THANK THE DOCTOR AND LEAVE.

PATIENT RECORDS MUST BE COLLECTED FRON ALL IN-SCOPE LOCATIONS

REGARDLESS OF ANSWER TO B -- PRINCIPAL RESPONSIBILITY.

38
-4-

4. A. During that week (REPEAT,DATES), how many ambulatory patients do you expect

to see in your office practice? (DO NOT COUNT PATIENTS SEENAT [OUT-OF-SCOPE

LoCATIONS] CODED IN 3-B.)

ENTER TOTAL UNDER “A” BELOW AND CIRCLE ON APPROPRIATE LINE.

B. And during those seven days (REPEAT DATES IF NECESSARY), on how many ~ do you

expect to see any ambulatory patients? COUNT EACH DAY IN WHICH DOCTOR EXPECTS

TO SEE ANY PATIENTS AT AN IN-SCOPE OFFICE LOCATION.

ENTER TOTAL UNDER “B” BELOW AND CIRCLE NUMBER IN APPROPRIATE COLUMN.

DETERMINE PROPER PATIENT LOG FORM FRON CHART BELOW. READ ACROSS ON

!!TOTALpATIENTS1~LINE ~DER ~lA!!AND CIRCLE LETTER IN APPROPRIATE

“DAYS” COLUNN UNDER “B.”

THIS LETTER TELLS YOU WHICH OF THE FOUR PATIENT LOG FORMS (A, B, C, D)

SHOULD BE USED BY THIS DOCTOR.

4

L

A. B.

Expected total Total @ in practice

LOG FORM DESCRIPTION atients during during week. _-—

I

survey week.

ENTER TOTAL FROM I ~AJ I

A--Patient Record is to be

completed for ALL -patients listed on Log.

B--Patient Record is to be

completed for every

SECOND patient listed

on Log.

C--Patient Record is to be

completed for every

THIRD patient listed

on Log.

*D--Patient Record is to be

completed for every

FIFTH patient listed

on Log.

Q. 4-A. I

J

1 2 3 4 5 6 7

1- 12 PATIENTS AAAAAAA

113-25’’ IBAAAA AA

I 26- 39 “ IcBAAA AA

I 93-105 ‘“ lDDc BBBB I

106-118 “ DDCCBBB

I 119-131 “ ID DCCBBB I

t 132-145 “ ID DDCCBB

146-158 “ DDDCCBB

159-171 II ID DDCCCC

172-184 “ DDDCCCC

185-197 “ DDDDDDD

198-210 “ DDDDDDD

211+ ,, DDDDDDD

*In the rare instance the physician will see more than 500 patients during his

assigned reporting week, give him two D Patient Log Folios and instruct him to complete

a patient record form for only every tenth patient. Then YOU are to draw an X or line

on line 5 on every other page of the two folio pads, starting with page 1 of the pad.

39
-5-

5. FIND PATIENT LOG FOLIO WITH APPROPRIATE LETTER AND ENTER LET1’SR AND NUMBER

OF THIS FORM HERE.

(Folio Number)

6. HAND DOCTOR HIS FOLIO AND EXPLAIN H(XJ FORMS ARE TO BE FILLED OUT. SHC%J DOCTCR

THE INSTRUCTIONS ON POCKET OF FOLIO AND ITEM 10 DEFINITIONS ON CARD IN FOLIO,

TO WHICH HE CAN RXFER AFTER YOU LEAVE.

RECORD VERBATIM BELOW ANY CONCERN, PROBLEMS OR QUESTIONS THE WCTOR RAISES.

7. IF DOCTOR EXPECTS TO SEE AMBULATORYPATIENTSAT MORE THAN ONE IN-SCOPELOCATION

DURINGASSIGNEDWEEK, TELL HIM YOU WILL DELIVER THE FORMS TO THE OTHER LOCATION(S).

ENTER THE FORM LETTER AND NUMBER(S) FOR THOSE LOCATIONS BELOW, BEFORE DELIVERING

FORM(S).

Location Patient Record Form Letter & Number

8. During the survey week (REPEAT EXACT DATES), will anyone be available to help

you in filling out these records (at each IN-SCOPE location)?

Yes . . .(ASKA) ..1

No . . . . . . . . .2

A. —IF YES. Who would that be? .

RECORD NAME, POSITIONAND LOCATION. r

B. —

*INTERVIEW:

WAS PERSON

BRIEFED

I NAME

BY YOU?

POSITION I LOCATION Yes I ~

I

12

I

12

I

12

I

12

*INTERVIEWER SHOULD BRIEF SUCH PERSON IF POSSIBLE.

40
-6-

9. DO you have a solo practice, or are you associated with other physicians in

a partnership, in a group practice, or in some other way?

solo. . . . . . . . . . . . I

Partnership . . . (ASK A-C). 2

Group . . . . . . (ASK A-C). 3

<--- Other (SPECIFY AND ASK A-C). 4

IF PARTNERSHIP, GROUP, OR OTHSR:

A. Is this a prepaid group practice? Yes . (ASK [1]) . .. 1

No. . . . . . . . .2

[1] IF YES TO A: What per cent

of patients are

prepaid? per cent

B. How many other physicians are

associated with you? NUMBER OF PHYSICIANS:

c. What are the specialties of the other physicians associated with you?

Specialty Number of Physicians

(1)

(2)

(3)

(4)

(5)

10. Now I have just one more question about your practice. (NOTE: IF LXICTORPRACTICES

IN LARGE GROUP, THE FOLLOWING INFORMATION CAN BE OBTAINED FRCM SOMEONE ELSE.)

A. What is the total number of full-time (35 hours or more per week) employees of your (partnership/

group) practice? Include personsregularlyemployddwho ● re now on vacation, temporarily ill,

etc. Do ~ include other physicians. RECORD ON ‘ioP LINE OF COLUMN A BELOW.

(1) Hov many of these full-time employees are a ... (READ CATEGORIES BELOW AS NECESSARY ANO

RECORD NUMBER OF EACH IN COLUMN A.)

B. And what is the total number of part-time (less than 35 hours per week) employees of your

(partnership/group) practice? Again, include persc.u+ regularly employed who are nov on vacation,

ill, etc. Do noc include other physicians. RECfjRG ON T13p LI~ OF COL~ B BELOW.)

(1) How many of these part-time employees are a ... (READ CATEGORIES BELOW AS NECESSARY AND

RECORD NUMBER OF EACH IN COLUMN B.)

A. B.

i+nployees Full-time Part -time

(35 or more hrmrs/week) (Less than 3S hours/week)

(1)

(2)

(3)

(4)

(5)

(6)

(7)

TUfAL:

Registered Nurse . . , . . . . . . . . .

Licensed Practical Nurse . . . . . . . .

Nursing Aide. . . . . . . . . . , . . .

*

Physician Assistant . . . . . . . . . .

Technician. . . . . . . . . . . . . . .

Secretary or Receptionist . . . . . . .

TOTAL:

Other (SPECIFY)

I

*

Physician Assistant must be ● graduste of an accredited training program for Physicisn Assistants

(Physician Extenders, Medex, etc. ) or certified by the National Board of Medical Examiners through the

Certification Exam for Assistant to the Primary Care Physician.

41
-7-

11. During the past seven (7) days, shout how many house calls did you make?

NUMBER OF HOUSE CALLS:

12. During the past seven (7) days, how many times did you provide to patients

advice or consultation by telephone?

None.. . . . . . . 1

1-9 . . . . . . . . 2

10-24 . , , , . . .3

25-49 . . , . . . .4

500rmore . . ...5

BEFORE YOU LEAVE, SIRESS THAT ~ AMBULATORYPATIENT SEEN BY THE DOCTOR DURING

THE 7-DAY PERIOD AT ALL IN-SCOPE OFFICE LOCATIONs (REPEAT THEM) IS TO BE lNCLUDED IN THE SURVEY~~T EACH PATIENT IS TO BE RECORDED ON THE LOG, AND ONLY

THE APPROPRIATE NUMBER OF PATIENT RECORDS COMPLETED.

Thank you for your time, Dr. If you have any (more) questions,

pleaae feel free to call me. My phone number is written in the folio. 1’11

call ~ on Monday morning of your survey wzek just to remind you.

13. TIME INTERVIEW ENDED . . . . . . . . . AM

PM

14. DATE OF INTERVIEW . . . . . . . . .

“Ccuul

(Month) (Bay) (Year)

IMMEDIATELY AFTER THE INTERVIEW. I

42
-8-

1. How much interest do you think the

doctor has in the survey?

Great interest . . . . . 1

Some interest . . . . . 2

Little interest . . . . 3

No interest . . . . . . f+

Can’ttell . . . . . . . 5

II. HOW confident are you that the

doctor will complete the forms?

Definitely will . . . . 1

Probably will . . . . . 2

Doubtful . . . . . . . 3

INTERVIEWER NUMEER

I I I I I I

INTERVIENER’S SIGNATURE

*U. S. GOVERWMZWT PRINTING OFFICE: 1978 260-937/19

43
VITAL AND HEALTH STATISTICS Series

Series I. Programs and Collection &ocedures. -Reports which describe the general programs of the National

Center for Health Statistics and its offices and divisions and data collection methods used and include

definitions and other material necessary for understanding the data.

Series 2. Data Evaluation and Methods Research. –Studies of new statistical methodology including experimental tests of new survey methods, studies of vital statistics collection methods, new analytical

techniques, objective evaluations of reliability of collected data, and contributions to statistical theory.

Series 3. Analytical Studies. –Reports presenting analytical or interpretive studies based on vital and health

statistics, carrying the analysis further than the expository types of reports in the other series.

Series 4. Documents and Committee Reports. – Final reports of major committees concerned with vital and

health statistics and documents such as recommended model vital registration laws and revised birth

and death certificates.

Series 10. Data From the Health Interview Sumey. –Statistics on illness, accidental injuries, disability, use of

hospital, medical, dental, and other services, and other health-related topics, all based on data collected

in a continuing national household interview survey.

Serirs 11. Data From the Health Examination Survey and the Health and Nutrition Examination Survey .–Data

from direct examination, testing, and measurement of national samples of the civilian noninstitutiormlized population provide the basis for two types of reports: (1) estimates of the medically defined

prevalence of specific diseases in the United States and the distributions of the population with respect

to physical, physiological, and psychological characteristics and (2) analysis of relationships among the

various measurements without reference to an explicit finite universe of persons.

Series 12. Data From the Institutionalized Population Surveys. –Discontinued effective 1975. Future reports from

these suweys will be in Series 13.

Serr”es 13. Data on Health Resources Utilization. –Statistics on the utilization of health manpower and facilities

providing long-term care, ambulatory care, hospital care, and family planning services.

Series 14. Data on Health Resources: Manpower and Facilities. –Statistics on the numbers, geographic distribution, and characteristics of health resources including physicians, dentists, nurses, other health

occupations, hospitals, nursing homes, and outpatient facilities.

Series 20. Data on Mortality. –Various statistics on mortality other than as included in regular annual or monthly

reports. Special analyses by cause of death, age, and other demographic variables; geographic and time

series analyses; and statistics on characteristics of deaths not available from the vital records based on

sample surveys of those records.

Series 21. Data on Natality, Marriagej and Divorce. –Various statistics on natality, marriage, and divorce other

than as included in regular annual or monthlv reports. Special analyses by demographic variables;

geographic and time series analyses; studies of fertility; and statistics on characteristics of births not

available from the vital records based on sample susveys of those records.

Series 22. Data From the Arational Mortality and Natality Survey s.–Discontinued effective 1975. Future reports

from these sample surveys based on vital records will be included in Series 20 and 21, respectively.

Series 23. Data From the Arational Survey of Family Growth. –Statistics on fertility, t%mi]y formation and dissolution, family planning, and related maternal and infant health topics derived from a biennial sumey

of a nationwide probability sample of ever-married women 15-44 years of age.

For a list of titles of reports published in these series, write to: Scientific and Technical Information Branch

National Center for Health Statistics

Public Health Service

Hyattsville, Md. 20782
——---- ,.. ...—

/