# Number 346 + August 26, 2004 

# National **Ambulatory Medical**  **Care Survey:**  **2002 Summary**  by David A. W oodwell and Donald K. Cherry , M.S., Division of Health Care Statistics 

# Abstract Objective— This report describes ambulatory care visits made to physician of

fices in the United States. Statistics are presented on selected characteristics of the physician’s practice, the patient, and the visit. This report also highlights visits to primary care specialties. Methods —The data presented in this report were collected from the 2002 National Ambulatory Medical Care Survey (NAMCS). NAMCS is a part of the ambulatory care component of the National Health Care Survey that measures health care utilization across various types of providers. NAMCS is a national probability sample survey of visits to of fice-based physicians in the United States. Sample data are weighted to produce annual national estimates. Selected trends from 1992, 1993, 1995, and 1997 are also presented. Results —During 2002, an estimated 890 million visits were made to physician of

fices in the United States, an overall rate of 314.4 visits per 100 persons. From 1992 through 2002, the visit rate for persons 45 years of age and over increased by 14%, from 407.3 to 465.8 visits per 100 persons. The visit rate to physician of fices in metropolitan statistical areas (MSAs) (337.3 visits per 100 persons) was significantly lar ger than the rate in non-MSAs (221.9 visits per 100 persons). For one-half of all of fice visits, regardless of specialty , physicians indicated they were the patient’s primary care physician (PCP). Of the visits to physicians other than the patient’s PCP , about one-third (31.1 percent) were referrals. New patients, representing 12.1 percent of the visits in 2002, are down 18% since 1992. Primary care specialists provided 90 percent of all preventive care visits. Essential hypertension, acute upper respiratory infection, diabetes mellitus, and arthropathies were the leading illness-related primary diagnoses. There were an estimated 104.0 million injury-related visits in 2002, or 36.7 visits per 100 persons. On average, 2.3 medications were ordered or provided at each of fice visit with any mention of a medication. The leading therapeutic class for drugs mentioned at of fice visits included nonsteroidal anti-inflammatory drugs (NSAIDs) (4.9 mentions per 100 visits) and antidepressants (4.5 mentions per 100 visits). Of primary care specialists, 25.8 percent reported not accepting new patients who are Medicaid enrollees. Keywords : ambulatory care c physician of fice care c diagnoses c injury c medications c ICD–9–CM c primary care 

# Introduction The National Ambulatory Medical Care Survey (NAMCS), which began in 1973, collects data on the utilization of ambulatory medical care services provided by of fice-based physicians. It was conducted annually until 1981, again in 1985, and resumed an annual schedule in 1989. The NAMCS is complemented by the National Hospital Ambulatory Medical Care Survey (NHAMCS), which was inaugurated in 1992 to expand the scope of data collection to the medical services provided by hospital outpatient and emer gency departments. T ogether , NAMCS and NHAMCS data provide an important tool for tracking ambulatory health care utilization in the United States. The NAMCS and NHAMCS are part of the National Health Care Survey (NHCS), which measures health care utilization across various types of providers. More information about the NHCS can be found at the National Center for Health Statistics (NCHS) W

e b site: www .cdc.gov/nchs/nhcs.htm
. More information on the 2002 NHAMCS annual summaries (hospital outpatient and emer gency departments) is available (1,2). A separate report combining NAMCS and NHAMCS data provides a comprehensive picture of ambulatory health care utilization (3). It shows that 80 percent of ambulatory


# U.S. DEP AR TMENT OF HEAL TH AND HUMAN SER VICES Centers for Disease Contr ol and Pr evention National Center for Health Statistics

# 2 **Advance Data**  **No. 346**  + **August 26,**  **2004**

care delivered by non-Federal physicians is provided in of fice-based practices. Hospital ambulatory patients are known to dif fer from of fice patients in certain demographic and medical characteristics. This report presents national annual estimates of physician of fice visits for 2002. Physician practice, patient, and visit characteristics are described. A special section is presented this year on visits to primary care specialists, and additional information is also presented throughout the report. 

# Data **Highlights Office**  **visit estimates**  + In 2002, 890.0 million visits were made to physician of fices, or about 314.4 visits per 100 persons. Of these visits, 62.7 percent were made to primary care specialists, 19.9 percent to sur gical specialists, and the remaining 17.3 percent to medical specialists. + From 1992 through 2002, the visit rate for persons 45 years of age and over increased by 14%, from 407.3 to 465.8 visits per 100 persons. + The visit rate for white persons (334.6 visits per 100 persons) was higher than for black or AfricanAmerican persons (252.9 visits per 100 persons) or Asians (229.3 visits per 100 persons). + Private insurance was the most frequently expected source of payment, accounting for 59.0 percent of all visits, and government sources combined (Medicare and Medicaid and/or State Children’ s Health Insurance Program (SCHIP)) accounted for 28.6 percent of visits. + From 1992 through 2002, the percent of visits by patients with private insurance increased by 79%, and the percent of visits where there was no third-party payer decreased by 77%. + Of visits made to of fice-based physicians, 13.9 percent were referred for the current visit. + There were 104 million injury visits to of fice-based physicians in 2002. The visit rate for injuries increased with patient age, resulting in a rate of 63.3 visits per 100 persons for patients 65 years of age and over . White persons had a significantly greater rate of injury visits than did black or African-American persons (39.6 versus 25.1 visits per 100 persons). Fifty percent were to primary care specialists. 

# Services **provided** + Although the rate of preventive care visits was higher for females than for males, there were no race dif ferences observed. T e n percent of preventive care visits were made to specialists. + Diagnostic and screening services were ordered or provided at 84.9 percent of visits, counseling and/or education and/or therapeutic services were ordered or provided at 44.7 percent of visits, and sur gical procedures were ordered or provided at 9.1 percent of visits. An estimated 69.8 million sur gical procedures were ordered, scheduled, or performed during of fice visits. Approximately 45 percent of the sur gical procedures mentioned at visits were performed in the of fice. + About 1.3 billion drugs were prescribed or provided at 64.8 percent of of fice visits. Although the percent of visits with any drug mention did not change, the average drug mention rate increased by 25% from 1992 to 2002. This was driven by a 41% increase in visits with multiple drugs prescribed since 1992. + Overall, the drug mention rate in 2002 was similar to 2001, but varied by physician specialty (60.7 versus 307.8 mentions per 100 visits). The drug mention rate for obstetrics/ gynecology (Ob/Gyn) physicians increased 48% from 2001, driven mostly by increases in contraceptives and vitamins. + The top three therapeutic classes, NSAIDs, antidepressants, and antihistamines, increased significantly from 1995. Antidepressants increased 48% during this period due to the increases in the drug mention rate for all ages. From 1995 through 2002, the drug mention rate at visits by children under 18 years of age rose 124%. + A physician was seen during most of

fice visits (95.1 percent). During approximately 25 percent of the visits a medical/nursing assistant was seen. 

# V **isits to**  **primary care**  **specialists** + The majority of the 890 million of fice visits were to primary care specialists (62.7 percent) and of these visits most were to the patient’ s PCP (76.2 percent). + Approximately 40 percent of the visits to primary care specialists were for acute problems, followed by 30 percent for chronic conditions. T e n percent were injury-related visits. + Of the 558 million visits to primary care specialists in 2002, 70.6 percent included at least one medication ordered, supplied, administered, or continued. V accines accounted for almost 6 percent of the drug mentions. + Half of the primary care visits resulted in a disposition to return for an appointment. 

# Physician-level **estimates** + In 2002, of fice-based physicians reported an average of 77 of fice visits, 14 hospital visits, 14 telephone consultations, 1.3 house calls, and 0.4 e-mail consultations during their last full week of practice. + Approximately three-fourths of of

fice-based physicians own or are part owner of their practice (72.7 percent). A greater percent of primary care specialists were employees compared with sur gical or medical specialists (28.2 percent versus 16.2 and 17.0 percent, respectively). T wo-thirds of primary care specialists work in group practices. + Of primary care specialists, 71.8 percent reported that they would accept new Medicare patients, a significantly lower percent than sur gical specialists (96.4 percent). Similarly , 67.4 percent of primary care specialists reported that they would accept new Medicaid patients,

# Advance **Data No.**  **346** + **August 26,**  **2004** 3 significantly lower than for sur gical specialists (80.0 percent). 

# Methods The data presented in this report are from the 2002 NAMCS, a national probability sample survey conducted by the Centers for Disease Control and Prevention’s Division of Health Care Statistics of the National Center for Health Statistics. The survey was conducted from December 31, 2001, through December 30, 2002. The tar get universe of the NAMCS includes visits made in the United States to the of fices of non-federally employed physicians (excluding those in the specialties of anesthesiology , radiology , and pathology) who were classified by the American Medical Association (AMA) and the American Osteopathic Association (AOA) as ‘ ‘of fice-based, patient care.’ ’ V isits to private, nonhospital-based clinics and health maintenance or ganizations (HMOs) were within the scope of the survey , but those that occurred in federally operated facilities and hospital-based outpatient departments were not. T elephone contacts and visits made outside the physician’s of fice were also excluded. The NAMCS utilizes a multistage probability sample design involving samples of primary sampling units (PSUs), physician practices within PSUs, and patient visits within physician practices. The PSUs are counties, groups of counties, county equivalents (such as parishes or independent cities), or towns and townships for some PSUs in New England. A sample of physicians was selected from the master files of the AMA and the AOA; 2,095 were in scope (eligible to participate in the survey). Sample physicians were asked to complete Patient Record forms (see figure I ) for a systematic random sample of approximately 30 of fice visits occurring during a randomly assigned 1-week reporting period. The weighted response rate for in-scope physicians was 71.1 percent, and a total of 28,738 Patient Record forms were completed. The ‘ ‘ T echnical Notes’ ’ a t the end of this report provide more information on independently keyed and coded. Coding characteristics of nonresponding error rates ranged between 0.1 and physicians. 1.1 percent for various survey items. Because the estimates presented in Several of the tables in this report this report are based on a sample rather present rates of physician of fice visits than on the entire universe of of fice per population. The population figures visits, they are subject to sampling used in calculating these rates are based variability
. The ‘ ‘ T echnical Notes’ ’ on the U.S. Census Bureau’ s monthly include an explanation of the sampling postcensal estimates of the civilian errors with guidelines for judging the noninstitutional population of the United precision of the estimates and States as of July 1, 2002. These information on physician and item population estimates are based on nonresponse. The standard errors are postcensal estimates from Census 2000 calculated using T aylor series and are available from the Census approximations in SUDAAN, which Bureau. See the ‘ ‘ T echnical Notes’ ’ for take into account the complex sample more information about the ef fects of design of the NAMCS (4). Data on the change from 1990-based to 2000- physician of fice utilization rates from based denominators on trends in 1992 through 2002 and selected trends population rates. Estimates presented in by patient age are also presented. A the tables and figures for specific race weighted least-squares regression categories reflect visits where only a analysis was used to determine the single race was reported. See ‘ ‘ T echnical significance of trends at the 0.05 level. Notes’ ’ for more detail on race The U.S. Census Bureau was estimates. responsible for data collection. Data processing operations and medical 

# Results coding were performed by Constella Group, Inc., Durham, North Carolina. Results are presented separately for As part of the quality assurance of fice visit estimates and physician procedure, a 10-percent quality control practice estimates. sample of survey records was

**Figure 1**  **. T**  **rends in**  **rate of**  **visits to**  **physician offices**  **by persons**  **45 years**  **o f**  **age and**  **over: United**  **S tates,**  **1995–2002**

# 4 **Advance Data**  **No. 346**  + **August 26,**  **2004 Office**  **visit estimates**  There were an estimated 890.0 million visits to of fice-based physicians in 2002, about 314.4 visits per 100 persons. Although the population of the United States increased by 13% since 1992, the number of visits to physician of

fices increased by 17% (5). V isit rates for age groups 45 years and over increased by 20% since 1995 ( figure 1 ). Selected characteristics of the encounter pertaining to the physician’s practice, the patient, and the visit are described later in this report. Estimates of physician practices and associated characteristics based on the induction interview are presented at the end of the report. Office practice characteristics —The distribution of of fice visits according to physician specialty is presented in table 1 and figure 2
. About one-quarter of all visits were to general and family practice physicians with an additional 39.0 percent of visits to physicians specializing in internal medicine, pediatrics, and Ob/Gyn. Of all the of fice visits made in 2002, about 6 out of every 10 were to physicians in primary care specialties (62.7 percent) as defined in table IV of the ‘ ‘ T echnical Notes.’ ’ Throughout this report, the terms ‘ ‘visits to primary care specialists/specialties’ ’

**Figure 2**  **. Percent**  **distribution o**  **f o**  **ffice v**  **isits by**  **physician specialty:**  **United S**  **tates, 2002** 

**Figure 3**  **. Annual**  **rate of**  **visits to**  **office-based physicians**  **by patient’**  **s age**  **and sex:**  **United S**  **tates, 2002**  

## and ‘ ‘primary care visits’ ’ will be used interchangeably
. Sur gical and medical specialties accounted for 19.9 and 17.3 percent of visits, respectively
. T

able 1 also shows that doctors of osteopathy received 65.4 million visits during 2002, or 7.3 percent of all of fice visits. V isits to osteopathic physicians occurred at a rate of 23.1 visits per 100 persons. V isits according to geographic region and metropolitan status are also displayed in table 1
. The visit rates were similar for each of the geographic regions, except the visit rate for the Northeast region (385.2 visits per 100 persons) was significantly higher than the rate in the W est (289.4 visits per 100 persons). The visit rate to physician of

fices located in MSAs (337.3 visits per 100 persons) was significantly lar ger than the rate observed in non-MSAs (221.9 visits per 100 persons). Additional information on the physician’s practice has been collected annually in the NAMCS through the Physician Induction Interview (PII) form. The PII is used to obtain basic information on the practice, establish the visit sampling rate, and record the final disposition of the interview
. I n 2002, selected survey items on the physician and physician’s practice, including employment status, ownership, practice size, and of fice type, were weighted and edited to produce national estimates of of

fice visits by these characteristics. These data demonstrate the type of practices to which visits are being made and are displayed in table 2
. Overall, 86.2 percent of the visits were to physicians who owned the practice themselves or owned it with a group of other physicians. The majority of of fice visits (64.7 percent) were made to physicians engaged in group practice. More than one-half of all visits were to physicians in practices with 2–9 physicians (53.0 percent) compared with 1 1.3 percent of visits to lar ge practices with 10 or more physicians. Significantly more visits to group practices were characterized as singlespecialty practices (41.2 percent) compared with multispecialty practices (23.5 percent). Patient characteristics —Of fice visits by patient’s age, sex, and race are shown in table 3
. A s i n previous years,

# Advance **Data No.**  **346** + **August 26,**  **2004** 5

**Figure 4**  **. Annual**  **rate of**  **visits to**  **office-based physicians**  **by patient’**  **s age**  **and race:**  **United S**  **tates, 2002**  

## females made the majority of of fice visits during 2002. The percent of visits was higher for females compared with males across all age groups except for persons under 15 years of age. Sex dif ferences were also observed for visit rates between 15 and 64 years of age. For those patients 15 years of age and over , a s age increased, the number of patient visits rose. The positive ef fect of age on physician of fice utilization is shown in figures 3 and 4
. White persons represented 81 percent of the U.S. civilian noninstitutional population in 2002, but made 86.1 percent of all physician of fice visits. Overall, the visit rate for white persons (334.6 visits per 100 persons) was significantly higher than for black or African-American persons (252.9 visits per 100 persons), Asians (229.3 visits per 100 persons), and American Indian or Alaska Native (82.9 visits per 100 persons). Historically , visit rates for black or African-American persons to physician of fices tend to be lower than those for white persons. However , dif ferences in visit rates by race can vary by type of health care setting utilized. Data presented in the 2002 NHAMCS outpatient department summary indicate that the visit rate for black or African-American persons (52.8 visits per 100 persons) was higher than for white persons (26.8 visits per 100 persons) (1). V isits made by patients identified as Asian accounted for 3.0 percent of all physician of fice visits, and patients who were Native Hawaiian or other Pacific Islander and American Indian or Alaska Native each accounted for about 1 percent of the of fice visits. Patients who claimed multiple race categories also accounted for 1 percent of of fice visits. Continuity of car e —Continuity of care is a goal of health care achieved through an interdisciplinary process involving patients, families, health care professionals, and providers in the management of a coordinated plan of care. It may involve multiple professionals from many dif ferent disciplines within multiple systems. The NAMCS collects information on aspects of care (e.g., whether the physician was the patient’ s primary care physician (PCP), whether the visit was a referral, and the number of visits within the past 12 months) that can help describe where the visit fits within the continuum of care for the patient. In 2002, 50.4 percent of physician of

fice visits were to the patient’ s PCP; 44.0 percent were to physicians other than the patient’ s PCP , and at 5.6 percent of visits it was unknown if the physician was the patients PCP ( table 4 ). V

isits by new patients were more likely to be referrals than visits made by established patients (46.3 percent versus 9.3 percent). T

able 5 describes visits to PCPs and non-PCPs in terms of referral status and physician specialty
. I t should be noted that not all visits to the patient’ s PCP were to physicians who specialize in primary care. Among visits to the patients’ PCP , 5.1 percent were to physicians specializing in either sur gical or medical specialties (data not shown). Among visits to non-PCPs, the specialties with visits most frequently referred by other physicians are neurology (55.2 percent), urology (50.9 percent), and orthopedic sur gery (45.5 percent). More than one-half of visits to Ob/Gyns, ophthalmologists, dermatologists, and psychiatrists were self referrals. T

able 6 shows the prior visit status, whether the care for the patient was shared by other physicians, and the episode of care. As shown, established patients accounted for 86.7 percent of of

fice visits. Three-quarters of of fice visits (75.6 percent) were made by established patients who had at least one previous visit in the last 12 months and more specifically , 22.7 percent had six or more visits in the previous 12 months. New patients accounted for 12.1 percent of visits representing an 18% decrease from 1992. Medical and sur gical care specialists were more likely to share care with other physicians (28.4 percent and 31.6 percent, respectively) compared with primary care specialists (18.4 percent). Primary expected sour ce of payment —Private insurance was cited most frequently as the primary expected source of payment (59.0 percent of visits). Government sources combined (Medicare and Medicaid and/or SCHIP accounted for 28.6 percent of of fice visits, most of which were Medicare ( table 7 )
. From 1992 through 2002, private insurance increased 79% (from 32.9 percent to 59.0 percent) and visits with no third-party payer (as defined by self-pay and no char ge/charity) decreased by 77% (from 20.7 to 4.7 percent) (data not shown). Primary care specialists saw a significantly greater percent of visits that were paid

# 6 **Advance Data**  **No. 346**  + **August 26,**  **2004**

**Figure 5**  **. Percent**  **distribution o**  **f o**  **ffice v**  **isits by**  **primary e**  **xpected source**  **of payment,**  **according to**  **patient age:**  **United S**  **tates, 2002**  

## (10.0 percent), and symptoms referable to the eyes and ears, which accounted for 5.5 percent of all visits ( table 8 ). The 20 most frequently mentioned principal reasons for visit, representing 42.5 percent of all visits, are shown in table 9
. General medical examination was the most frequently mentioned reason for visit at 7.3 percent of all of

fice visits, and cough was the most frequently mentioned reason regarding an illness or injury (3.2 percent). All but two of the reasons for of fice visits in 2002 were listed in the 20 most frequently mentioned reasons in 2001, albeit in a dif ferent order
. I t should be noted that estimates dif fering in ranked

where private insurance (63.3 percent) was the primary expected source of payment than did sur gical specialtists (52.4 percent) or medical specialtists (51.4 percent). V isits that had a primary expected source of payment of either Medicare or Medicaid/SCHIP represented a significantly greater percent of visits to sur gical specialists compared with primary care specialists (34.5 percent versus 26.3 percent) (data not shown). As expected, source of payment varied by patient age ( figure 5 ). Private insurance was the primary expected source of payment at a majority of visits by patients under age 65 years and only represented 17.8 percent of visits by persons 65 years of age and over . Three-quarters of visits by elderly patients listed Medicare as the primary source of payment at of fice visits (74.2 percent). Private insurance accounted for a lar ger share of visits in MSAs as opposed to non-MSAs (60.8 versus 48.3 percent, respectively) (data not shown). Medicare and Medicaid accounted for a greater share of visits in non-MSAs as opposed to MSAs (27.5 and 13.4 percent in non-MSAs versus 20.1 and 6.6 percent in MSAs). Patient’s principal r eason for visit —The principal reason for visit is the main complaint, symptom, or reason listed for why the patient came to the physician’s of fice. Up to three reasons for visit were coded according to A Reason for V isit Classification for Ambulatory Car e (R VC) (6). The R V C is a classification scheme developed by NCHS that has been used for over 20 years to code patients’ complaints or reasons for seeking care. It is divided into eight modules or groups of reasons as shown in table 8 and includes all the reasons for which patients see their physicians. This includes symptoms, followup for prior diagnoses, routine examinations and screening, treatment for conditions and operations, various therapies, and injuries. Also included are visits to receive test results and to fulfill third-party requirements for a physical examination, such as for employment or a driver’s license. The symptoms module is further divided into symptoms that refer to specific body systems, such as digestive or respiratory
. Each reason is assigned a three- or four -digit classification code (e.g., S845-
‘ ‘Symptoms of skin mole’ ’ i s further detailed to S845.1- ‘ ‘Change in size and color ’ ’ and S845.2- ‘ ‘Bleeding mole’ ’). In 2002, one-half of all visits were made for reasons classified as symptoms. Some of the more prominent symptoms included respiratory (10.5 percent), musculoskeletal order may not be significantly dif ferent from each other
. The major reason for this visit provides a better picture of the general nature of the of fice visit—whether for an acute problem; routine visit for a chronic problem; visit for a flare-up of a chronic problem; pre- or post-sur gery visit; or for preventive care, including routine prenatal examinations, general medical examinations, well-baby examinations, screening, and examinations for insurance purposes. The major reason for visit item dif fers from the principal reason for visit item in that the former represents the physician’s rather than the patient’s perspective of the major reason why the patient sought care. Acute problems comprised 36.4 percent of the visits, and routine chronic problems accounted for 29.7 percent ( table 10 )
. Approximately 16.3 percent of all visits were for preventive care. A higher percent of visits by females were for preventive care compared with visits by males. The percent of visits for acute and preventive care declined with patient age, whereas the percent of visits for chronic conditions increased with patient age. T able 1 1 describes the frequency of preventive care visits by patient, visit, and physician characteristics. The female visit rate for preventive care was significantly greater than the rate for males (66.9 visits per 100 females versus 34.6 visits per 100 males). These sex dif ferences reflect, in part, the fact that preventive care includes prenatal examinations that usually include

# Advance **Data No.**  **346** + **August 26,**  **2004** 7 multiple visits within 1 year . I n 2002, 18.1 percent of the preventive visits made by females also included a visit made for normal pregnancy (any diagnosis coded V22) (data not shown). However , even after removing visits for normal pregnancy , females still had a higher visit rate (54.8 visits per 100 females) compared with males (34.6 visits per 100 males) (data not shown). There was no dif ference in visit rates for preventive care by sex among children under 15 years of age or among the elderly (65 years old and over). Uninsured persons (as measured by self-pay and charity visits) had a much lower preventive care visit rate compared with persons with private or public health insurance, placing them at a potential disadvantage for disease prevention and early diagnosis. Primary diagnosis —Physicians were asked to record the primary diagnosis or problem associated with the patient’s most important reason for the current visit and any other significant current diagnoses. Up to three diagnoses were coded according to the International Classification of Diseases, 9th Revision, Clinical Modification (ICD–9–CM) (7). T able 12 shows of fice visits by the physician’ s primary diagnosis using the major disease categories specified in the ICD–9–CM. The supplementary classification, used for diagnoses that are not classifiable to injury or illness (for example, general medical examination, routine prenatal examination, and health supervision of an infant or child), accounted for 16.4 percent of all of fice visits. Diseases of the respiratory system (12.6 percent), diseases of the circulatory system (9.0 percent), and diseases of the nervous system and sense or gans (8.9 percent) were also prominent categories on the list. The 20 most frequently reported primary diagnoses for 2002, accounting for 42.8 percent of all physician of fice visits, are shown in table 13
. The categories in this table are also based on the ICD–9–CM. The leading illness diagnoses include essential hypertension, acute upper respiratory infections (excluding pharyngitis), diabetes mellitus, arthropathies and related disorders, and spinal disorders. Injury-r elated visits —Although there is a separate item or checkbox on the Patient Record form to indicate whether the visit was for an injury , poisoning, or adverse medical treatment, sometimes an injury reason for visit is specified or an injury diagnosis is rendered without the injury item being checked. Therefore, the visit is counted as an injury visit and the injury checkbox is coded ‘ ‘ Y es’ ’ i f any of the three reasons for visit were in the injury module or any of the three diagnoses were in the injury or poisoning chapter of the ICD–9–CM. This provides a better indicator that the visit involves an injury than using the reason for visit module, ICD–9–CM injury diagnosis, or the unedited injury item alone. A more detailed discussion is documented elsewhere (8). There were an estimated 104.0 million injury- or poisoning-related of

fice visits in 2002, representing 1 1.7 percent of all visits and yielding a rate of 36.7 visits per 100 persons ( table 14 )
. The injury-related visit rate increased significantly with patient age. The rate for patients aged 75 years and over (63.3 visits per 100 persons) was approximately double that of the three age groups under 45 years of age. The injury-related visit rate for females was not significantly dif ferent from the rate for males nor were there dif ferences between the female and male rates when compared by each of the specific age groups. The overall injury-related visit rate for white persons (39.6 visits per 100 persons) was higher than the injury-related rate for black or AfricanAmerican persons (25.1 visits per 100 persons) and persons of ‘ ‘other ’ ’ race (23.6 visits per 100 persons). Small sample sizes preclude analysis by age within some race groups. Half of the injury visits were to primary care specialists (50.5 percent) with no significant dif ference between white and black or African-American persons (data not shown). Further information on injury visits to physician of fices is available on the public-use file, including external cause-of-injury codes (E-codes) and a narrative of the cause of injury
. Of fice visits by intent and mechanism of the first-listed E-codes are shown in table 15
. U p t o three external causes of injury were coded according to the ‘ ‘Supplementary Classification of External Causes of Injury and Poisoning’ ’ i n the ICD–9– CM (7). Cause of injury was not recorded for 38.0 percent of injuryrelated visits, so the observed distribution could change with more complete reporting. For a detailed description of the cause-of-injury codes, refer to table III in the ‘ ‘ T echnical Notes.’ ’ Diagnostic and scr eening services

— T able 16 displays examinations and diagnostic and screening services ordered or provided by physicians during of fice visits. At least one such service was ordered or provided at 84.9 percent of of fice visits, resulting in approximately 204 services per 100 visits. Information on diagnostic services was missing for 0.9 percent of visits. The most frequently occurring diagnostic service was a general medical examination; one-half of all visits (49.7 percent) included a general medical examination. Some of the most frequent laboratory tests ordered included urinalysis (9.6 percent), complete blood count (8.8 percent), and cholesterol (5.2 percent) ( table 16 )
. Imaging was ordered or provided at 10.9 percent of visits; the majority of imaging services were x-rays. V isits by females were more likely to have imaging performed compared with visits by males, a dif ference due mostly to mammographies. The percent of visits that had any imaging ordered or provided increased significantly from 3.9 percent in 1993 to 4.5 percent in 2002 (data not shown). Counseling/education and therapeutic services —Therapeutic and preventive services (not including medication therapy , which was reported separately) were ordered or provided at 44.7 percent of all of fice visits during 2002, resulting in approximately 68 services per 100 visits. The most frequent counseling or education provided at of fice visits related to diet and/or nutrition (14.3 percent) and exercise (10.0 percent) ( table 17 )
. Females were just as likely as males to have any one of the 10 listed

# 8 **Advance Data**  **No. 346**  + **August 26,**  **2004** counseling, education, or therapeutic services ordered or provided at an of fice visit. Information regarding therapeutic services was missing for 2.1 percent of visits. Pr

ocedur es —In item 8 o f the Patient Record form, physicians were instructed to record up to two sur gical procedures ordered, scheduled, or performed at the visit. Item 6,
‘ ‘Diagnostic and screening services,’ ’ included two open-ended ‘ ‘other ’ ’ categories in addition to the checkbox categories. After analyzing data from the
‘ ‘other ’ ’ categories and the sur gery checkbox (item 8), it was discovered that the same procedure was being recorded in dif ferent places on dif ferent records. T able 18 presents data from item 8 and the open-ended responses to item 6 a s coded to ICD–9–CM volume 3 i n the range of 01–86 (7). During 2002, there were an estimated 69.8 million sur gical procedures ordered or performed during visits to of fice-based physicians resulting in approximately 10 sur gical procedures per 100 visits. About 9.1 percent of visits had such procedures ordered or performed (up by 72% since 1992) (data not shown). About 45 percent of sur gical procedures were performed in the of fice. Medication therapy —NAMCS respondents were instructed to record all new or continued medications ordered, supplied, or administered at the visit. This included prescription and nonprescription preparations, immunizations, desensitizing agents, and anesthetics. Up to six medications, referred to in this survey as drug mentions, were coded according to a classification system developed at NCHS. A report describing the method and instruments used to collect and process drug information is available (9). As used in the NAMCS, the term
‘ ‘drug’ ’ i s interchangeable with the term
‘ ‘medication,’ ’ and the term
‘ ‘prescribing’ ’ i s used broadly to mean ordering or providing any medication, whether prescription or over the counter . V

isits with one or more drug mentions are termed ‘ ‘drug visits’ ’ i n the NAMCS. Data on medication therapy are in tables 19–23
. Medication therapy was reported at 577.1 million of fice visits, accounting **Figure 6**  **. T**  **rends in**  **drug mention**  **r ates**  **for NSAIDs,**  **antidepressants, and**  **antihistamines at**  **physician office**  **v isits:**  **United S**  **tates, 1995–2002** 


## for 64.8 percent of all of fice visits ( table 19 ). During 2002, there were about 1.3 billion drugs mentioned, resulting in an overall drug mention rate of 151.4 mentions per 100 visits. Data on drug visits and drug mentions by physician specialty are shown in table 20
. The percent of visits with at least one drug mention ranged from 82.6 percent for psychiatrists to 28.1 percent for general sur geons. The overall drug mention rate was similar to last year ’ s ; however , the drug mention rate for Ob/Gyn physicians increased 48% from 55.5 mentions per 100 visits in 2001 to 82.4 mentions per 100 visits in 2002 (data not shown). Increases in Ob/Gyn drug mention rates were driven by a 24% increase in the percent of visits with any mention of drugs (from 39.6 to 48.9 percent) and a 60% increase in the mention of contraceptives and vitamins. The drug mention rate for other physician specialties was not significantly dif ferent from 2002. T

able 21 presents the 20 most frequent therapeutic classes of drug mentions by four -digit therapeutic classification codes used in the National Drug Code (NDC) Dir ectory , 1995 edition. Drugs may have more than one therapeutic application, and up to three therapeutic drug classes are recorded for each drug (10). Prior to 2002, a drug was classified under its primary therapeutic use and data were presented for two-digit therapeutic classification codes. Beginning in 2002, drug data are shown for up to three therapeutic subclassifications at the four -digit level. In 2002, the leading drug subclasses were NSAIDs (4.9 percent), followed by antidepressants (4.5 percent), antihistamines (4.3 percent), antiasthmatics or bronchodilators (4.0 percent), and vaccines or antisera (4.0 percent). Examining the top three therapeutic drug classes further , figure 6 shows that between 1995 and 2002 the drug mention rates per 100 visits for NSAIDs, antidepressants, and antihistamines have all increased significantly (10%, 48%, and 35%, respectively). Increases in drug mention rates by therapeutic class can be driven by numerous factors including how new drugs are classified by the Food and Drug Administration (FDA) and the level of marketing these drugs receive. For example, increases in NSAIDs are directly attributed to the new subclass of drugs called COX-2 inhibitors. Sales of Celebrex and V ioxx have grown briskly since their approval as priority new molecular entities (NMEs) and from intensive marketing aimed at both consumers and physicians (1 1). Since 1999, the number of NAMCS drug mentions for Celebrex increased 44% and since 2000 V ioxx mentions

# Advance **Data No.**  **346** + **August 26,**  **2004** 9

**Figure 7**  **. T**  **rends in**  **antidepressant drug**  **mention r**  **ates at**  **physician office**  **v isits**  **by patient’**  **s age:**  **United S**  **tates, 1995–2002**  

## increased 17%. Direct-to-consumer Many factors have also been (DTC) marketing, along with the attributed to the rise in antidepressant creation of nonsedating second- and drug mention rates. Figure 7 shows third-generation drugs, represent two trends from 1995 through 2002 among major reasons for the rise in the four age groups: under 18 years, 18–44 antihistamine mention rate since 1995 years, 45–64 years, and 65 years and (12,13). The leading antihistamine over . The rate of visits with mentioned in 2002 was Zyrtec, which antidepressants mentioned significantly was approved by the FDA in 1996. increased for all age groups, with visits Other leading antihistamines include by younger patients showing the lar gest Allegra and Claritin. rate increase from 1995. For patients under 18 years of age, the number of

**Figure 8**  **. T**  **rends in**  **the d**  **rug mention**  **r ates**  **for antidepressants**  **b y**  **subclass at**  **physician office**  **v isits:**  **United S**  **tates, 1992–2002**  

## mentions per 100 visits increased 124%; for patients aged 18–44 years, the rate increased 57%; the rate increased 39% for patients aged 45–64 years; and increased 29% for seniors aged 65 years of age and over . Observed increases in NAMCS antidepressant mention rates were not surprising given the fact that from 1987 through 1997, more individuals were being treated for depression. T reatments typically involved more psychotropic medications and comparatively less psychotherapy , and physicians became more involved in the treatment of depression versus other mental health professionals (14). Research has suggested that an increase in antidepressant prescribing has been directly related to the introduction of the new subclass of antidepressants called selective serotonin reuptake inhibitors (SSRIs) (15). Compared with all other classes of antidepressants, SSRIs now represent the preferred class of drugs used by physicians in treating patients with major depression. These drugs are especially attractive alternatives to older , once popular , tricyclic antidepressants (TCAs) because they typically possess fewer adverse side ef fects, have a reduced risk of suicide-related deaths, involve simpler dosing patterns, and have equivalent antidepressant ef

fectiveness as TCAs (16). Figure 8 demonstrates this increase in SSRIs and decrease of TCAs. Since 1992, SSRIs have increased from 0.7 drug mentions per 100 visits to 4.1 drug mentions per 100 visits in 2002, an increase of approximately 500%. TCAs declined from 1.5 drug mentions per 100 visits in 1992 to 0.8 drug mentions per 100 visits in 2002, a decrease of approximately 47%. The 20 most frequently used generic substances for 2002 are shown in table 22
. Drug products containing more than one ingredient (combination products) are included in the data for each ingredient. For example, acetaminophen with codeine is included in both the count for acetaminophen and the count for codeine. Compared with the 19 other generic substances and consistent with previous years, acetaminophen was most frequently used in drugs ordered or provided by the physician at of fice visits, occurring

# 10 **Advance Data**  **No. 346**  + **August 26,**  **2004** in 3.4 percent of drug mentions. This nurse practitioners, and/or midwives, was followed by amoxicillin, were seen at 3.1 percent of physician hydrochlorothiazide, albuterol, and of fice visits. aspirin. V isit disposition —Staf f were asked T

able 23 presents the 20 to record all visit dispositions and medications most frequently mentioned instructed that multiple responses could by physicians in the NAMCS according be coded for this item. For 6 out of 10 to the name written on the Patient visits (60.4 percent), patients were told Record form. This could be a brand to return to the of fice by appointment name, generic name, or therapeutic ( table 25 )
. ‘ ‘Return if needed’ ’ and ‘ ‘no ef

fect. Lipitor accounted for 18.8 followup planned’ ’ were indicated at million mentions (1.4 percent of the 27.4 and 8.5 percent of visits, total) and was followed by albuterol, respectively
. Patients were referred to amoxicillin, Synthroid, and Lasix. other physicians at 7.3 percent of visits. Fifteen of these drugs were among the T ime spent with physician —Data on top 20 drug entry names mentioned in the duration of of fice visits are 2001. presented in tables 26 and 27
. T ime Pr

oviders seen —In this item, staf f spent in face-to-face contact between the were asked to check all of the providers physician and the patient is estimated seen during the visit. Overall, and recorded by the physician. It 95.1 percent of visits were attended by a excludes time spent waiting to see the physician ( table 24 )
. Medical and/or physician, time spent receiving care nursing assistants were seen at from someone other than the physician 27.3 percent of of fice visits. Midlevel without the presence of the physician, providers, such as physician assistants, and time spent by the physician in

**Figure 9**  **. Characteristics**  **o f**  **v isits**  **to office-based**  **physicians, by**  **specialty: United**  **S tates,**  **2002** 

## reviewing patient records and/or test results. In cases where the patient received care from a nonphysician member of the physician’s staf f, but did not actually see the physician during the visit, the duration was recorded as ‘ ‘0’ ’ minutes. In 2002, 88.3 percent of of fice visits with face-to-face contact between the physician and patient had a duration between 6 and 30 minutes ( table 26 )
. At 43.8 million visits, or 4.9 percent, there was no face-to-face contact between the physician and patient. T able 27 shows the mean duration for all visits at which a physician was seen as well as the mean duration at each quartile by physician specialty
. Overall, the mean time spent with a physician was 18.4 minutes. The visit duration for psychiatrists had the lar gest variability (a dif ference of 28.4 minutes between the third and first quartiles). V

isits to primary car e specialists —In 2002, the NAMCS sampled an additional 150 primary care specialty physicians in order to provide more analytical power for understanding primary care. Detailed information on the sample and definitions of primary care physicians can be found in the
‘ ‘ T echnical Notes.’ ’ This section highlights visits to primary care specialists. V

isits to primary care specialties accounted for 62.7 percent of the 890 million visits to of fice-based physicians in 2002 ( table 1 )
. Approximately three-fourths of these visits were to the patient’ s designated PCP
. Approximately 8 percent of visits to primary care specialties were by new patients, and most established patients had seen their physician in the last 12 months (79.5 percent) ( table 6 ). The percent of visits made to primary care specialists where the patient was responsible for the payment was significantly less than at visits made to medical specialists (3.8 percent versus 8.0 percent) (Data not shown). The role of preventive care in primary care specialists can be seen from the last two columns in table 1 1
. Approximately 9 out of 10 preventive care visits were to primary care specialists; however , receipt of preventive care from primary care specialists decreases with age.

# Advance **Data No.**  **346** + **August 26,**  **2004** 11
**Characteristics of**  **visits to**  **primary care**  **specialists:** + Accounted for 62.7 percent of all visits in 2002, with 75 percent to the patient’ s designated primary care provider
. + Major reason for visit to primary care specialists: o Acute conditions—41.5 percent o Chronic conditions—29.6 percent o Preventive care—23.3 percent + T o p five illness-related diagnoses are: o Hypertension—7.8 percent o Acute upper respiratory infections (excluding pharyngitis)—5.1 percent o Diabetes mellitus—3.1 percent o Otitis media—2.4 percent o Arthropathies—2.1 percent + Injury visits accounted for 9.4 percent of all visits to primary care specialists. + Common services ordered or provided: o General medical examination—60.8 percent o Blood pressure check—60.1 percent o Urinalysis—12.8 percent o Complete blood count (CBC)—10.9 percent o Diet/nutrition counseling—19.3 percent o Exercise counseling—12.2 percent + T o p therapeutic drug classes were: o V accines/antisera—5.7 percent of drug mentions o NSAIDs—5.5 percent of drug mentions o Antihistamines—4.8 percent of drug mentions o Antidepressants—4.0 percent of drug mentions o Antihypertensives—3.9 percent of drug mentions o Antiasthmatics—3.8 percent of drug mentions + Disposition of visit: o Return for an appointment—53.4 percent o Return if needed—33.4 percent o Referred to another physician—8.0 percent + A verage face-to-face duration—17.4 minutes.

Figure 9 summarizes characteristics of of fice visits by physician specialty type and contrasts primary care with sur gical and medical specialties. Primary care specialists managed 165 problems per 100 visits. They ordered or provided 235 diagnostic and screening services, 165 medications, 76 counseling/ education services, and 5 sur gical procedures per 100 visits. Acute conditions accounted for 41.5 percent of visits to primary care specialties followed by 29.6 percent for chronic conditions and 23.3 percent for preventive care (see textbox). The leading illness-related primary diagnoses at primary care specialty visits included essential hypertension (7.8 percent), acute upper respiratory infection (excluding pharyngitis) (5.1 percent), diabetes mellitus (3.1 percent), otitis media (2.4 percent), and arthropathies (2.1 percent). Normal pregnancy visits accounted for 3.1 percent of primary diagnoses at these visits. About 1 i n 1 0 visits were for an injury
. Six of ten visits to primary care specialists (60.8 percent) had a general medical examination, a significantly higher percentage than for visits to sur gical specialists (23.4 percent) and medical specialists (39.8 percent). Overall, a blood pressure check occurred at 48.1 percent of all visits ( table 16 ) ; however , blood pressure checks varied by physician specialty
. Although primary care specialists indicated that they checked the patient’ s blood pressure at three-fifths of visits, medical specialists reported blood pressure checks at two-fifths of visits, and sur gical specialists performed such checks at one-fifth of visits (data not shown). Drugs were prescribed at 70.6 percent of the visits to primary care physicians. The leading therapeutic classes prescribed include vaccines (5.7 percent of drug mentions), NSAIDs (5.5 percent), antihistamines (4.8 percent), antidepressants (4.0 percent), antihypertensives (3.9 percent), and antiasthmatics (3.8 percent). Patients at primary care visits were told to return for an appointment at 53.4 percent of visits, told to return if needed at 33.4 percent of visits, and referred to another physician at 8.0 percent of visits. The average duration of primary care visits was 17.4 minutes. 

# Physician-level **estimates** The NAMCS provides information on characteristics of physician of fices as well as information about the frequency of of fice visits, the characteristics of patients, diagnoses rendered, and services provided at the visit. In the Physician Induction Interview (PII), participating physicians were asked several questions about their practice such as other kinds of patient encounters (e.g., telephone, e-mail), involvement with managed care contracts, and willingness to accept new patients. The data were weighted to provide annual estimates for all non-Federal, officebased physicians primarily engaged in patient care. T able 28 provides national estimates for of fice-based physicians in 2002. There were an estimated 308,023 of

fice-based physicians in practice in any given week in the United States (SE=8,149). This estimate excludes physicians in the specialties of radiology , anesthesiology , o r pathology
. One-half of these physicians (50.2 percent) were in primary care specialties, 25.5 percent were in sur gical specialties, and 24.3 percent in medical specialties. Although similar to the visit level data shown in table 1 , table 28 shows

# 12 **Advance Data**  **No. 346**  + **August 26,**  **2004** that about one-third of the physicians were in solo practices with the remaining in either single- or multispecialty-group practices (41.0 and 24.7 percent, respectively). The majority of physicians were the owners or part owners of their practices (72.7 percent). Primary care specialists were employees a greater percent of the time compared with sur gical or medical specialists (28.2 percent versus 16.2 and 17.0 percent, respectively). Another practice characteristic collected in the PII is the number of encounters the physician makes during his/her last full week of practice. These include: of fice visits, home visits, hospital visits, telephone consultations, and internet/e-mail consultations. T

able 28 presents the percent of physicians who had at least one of each of the various encounters during their last full week of practice and, for those physicians with at least one, the mean number for each of the encounters. For example, 19.1 percent of primary care specialists reported having at least one home visit during their last full week of practice. Of these physicians the mean number of reported home visits was 1 1.7. Primary care specialists reported more telephone contacts (26.3) than sur gical specialists (1 1.5) or medical specialists (15.7). Medical specialists made more hospital visits (34.1) than did sur gical (17.6) or primary care specialists (17.0). Not shown in table 28 is the mean number of each of the weekly encounters for all physicians: 77 of

fice visits, 14 hospital visits, 14 telephone contacts, 1.3 house calls, and 0.4 internet/e-mail consults. The NAMCS PII asks physicians about their willingness to accept new patients. Ninety-five percent of the physicians said they would accept new patients, ( table 28 )
. Figure 10 shows the percent of physicians who said they would not accept new patients by payment source. Approximately 37.7 percent of of fice-based physicians did not accept new charity cases (as defined by the no char ge check box), 23.5 percent did not accept new Medicaid cases, and 13.8 percent did not accept new Medicare cases. Primary care specialists were more likely to refuse new Medicare cases **Figure 10.**  **Percent of**  **office-based physicians**  **who do**  **not accept**  **new patients**  **who use**  **selected payment**  **methods: United**  **S tates,**  **2002** 

## (21.1 percent) compared with either sur gical specialists (2.0 percent) or medical specialists (12.0 percent) and more likely to refuse Medicaid cases (25.8 percent) compared with sur gical specialists (17.6 percent) (data not shown). A greater percent of physician practices used electronic billing records than electronic medical records (74.4 percent versus 17.3 percent) due to the requirement by Medicare and Medicaid. Additional information about physician of fice utilization is available from the NCHS Ambulatory Health Care W e b site: http://www .cdc.gov/nchs/about/ major/ahcd/ahcd1.htm
. Individual-year reports and public-use data files are available for download from the W e b site. Data from the 2002 NAMCS will also be available on a public-use data tape and CD-ROM. These and other products can be obtained by contacting the NCHS Ambulatory Care Statistics Branch at (301) 458-4600. Queries regarding NAMCS data may be sent to NCHS via nchsquery@cdc.gov
. 

# References 1. Hing ES, Middleton, KR. N ational Hospital Ambulatory Medical Care Survey: 2002 outpatient department summary . A dvance data from vital and health statistics; no 345. Hyattsville, Maryland: National Center for Health Statistics. 2003. http://www .cdc.gov/nchs/data/ad/ ad345.pdf 2. McCaig LF , Burt CW
. N ational Hospital Ambulatory Medical Care Survey: 2002 emer gency department summary . A dvance data from vital and health statistics; no 340. Hyattsville, Maryland: National Center for Health Statistics. 2003. http://www .cdc.gov/nchs/data/ad/ ad340.pdf 3. Burt CW , Schappert SM. Ambulatory care visits to physician of fices, hospital outpatient departments, and emer gency departments. United States, 1999–2000. National Center for Health Statistics. V ital Health Stat. 13(157). 2004. 4. Research T riangle Institute. SUDAAN user’s manual, release 8.0. Research T riangle Park, NC: Research T riangle Institute. 2002. 5. Schappert SM. N ational Ambulatory Medical Care Survey: 1992 summary . A dvance data from vital and health statistics; no 253. Hyattsville, Maryland: National Center for Health Statistics. 1994. http://www .cdc.gov/nchs/data/ad/ ad253.pdf 6. Schneider D, Appleton L, McLemore T
. A reason for visit classification for ambulatory care. National Center for Health Statistics. V ital Health Stat 2(78). 1979. 7. Public Health Service and Health Care Financing Administration. International Classification of Diseases, 9th Revision, Clinical

# Advance **Data No.**  **346** + **August 26,**  **2004** 13 Modification, 6th ed., W ashington: Public Health Service. 1998. 8. Burt CW , Fingerhut LA. Injury visits to hospital emer gency departments: United States, 1992–95. National Center for Health Statistics. V ital Health Stat 13(131). 1998. http:// www .cdc.gov/nchs/data/series/sr_13/ sr13_131.pdf 9. Koch H, Campbell W
. The collection and processing of drug information. National Ambulatory Medical Care Survey , United States, 1980. National Center for Health Statistics. V ital Health Stat 2(90). 1982. 10. Food and Drug Administration. National Drug Code Directory , 1995 edition. W ashington: Public Health Service. 1995. 1 1. Hunt M. Changing Patterns of Pharmaceutical Innovation. NIHCM Foundation Research Report. W

ashington: National Institute for Health Care Management. May 2002. 12. McCue JD. Safety of antihistamines in the treatment of aller gic rhinitis in elderly patients. Arch Fam Med 5(8): 464–8. 1996. 13. Lipsky MS, T aylor CA. The opinions and experiences of family physicians regarding direct-to-consumer advertising. J Fam Pract 45(6): 495. 1997. 14. Olfson M, Marcus SC, Druss B, Elinson L, T anielian T, Pincus HA. National trends in the outpatient treatment of depression. JAMA 287(2): 203–9. 2002. 15. Pincus HA, T anielian TL, Marcus SC, Olfson M, Zarin DA, Thompson J, Zito JM. Prescribing trends in psychotropic medications: primary care, psychiatry , and other medical specialties. JAMA; 279(7): 526–31. 1998. 16. Preskorn, SH. Clinical pharmacology of SSRI’ s. Professional Communication, Inc. 1996. http:// www .preskorn.com/books/ ssri_open.html
. 17. Sirken MG, Shimizu I, French DK, Brock DB. Manual on Standards and Procedures for Reviewing Statistical Reports. Hyattsville, Maryland: National Center for Health Statistics. 1990. 18. Of fice of Management and Budget (1997), Statistical Policy Directive No 15, Race and Ethnic Standards for Federal Statistical and Administration Reporting, Federal Register; part II: 36873–36946, July 7, 1997.

# 14 **Advance Data**  **No. 346**  + **August 26,**  **2004 T** 

**able 1**  **. Number**  **, percent**  **distribution, and**  **annual rate**  **of office**  **visits with**  **corresponding standard**  **e rrors,**  **b y**  **selected physician**  **practice characteristics:**  **United S**  **tates, 2002**  Number of Number of Standard Standard visits per Standard

visits in error i n Percent error o f 100 persons error Physician practice characteristics thousands thousands distribution percent per year 1,2 of rate A l l v i s i t s ..................................... 889,980 28,1 1 0 100.0
. . . 314.4 9 .9 Physician specialty General and family practice

......................... 215,466 13,1 1 7 24.2 1 .2 76.1 4 .6 Internal medicine

................................ 156,692 14,734 17.6 1 .4 55.4 5 .2 Pediatrics

.................................... 120,018 8,213 13.5 0 .9 3 198.1 13.6 Obstetrics and gynecology

.......................... 7 0 , 3 2 4 6 , 4 1 0 7
. 9 0
. 7 4 60.9 5 .6 Ophthalmology

................................. 4 9 , 9 3 7 5 , 5 6 8 5
. 6 0
. 6 1 7
. 6 2
. 0 Orthopedic surgery ............................... 3 8 , 0 2 8 5 , 0 2 7 4
. 3 0
. 6 1 3
. 4 1
. 8 D e r m a t o l o g y ................................... 3 2 , 2 2 7 3 , 8 1 9 3
. 6 0
. 4 1 1
. 4 1
. 3 Psychiatry

.................................... 2 1 , 6 5 9 2 , 9 7 9 2
. 4 0
. 3 7
. 7 1
. 1 Cardiovascular diseases

........................... 2 0 , 8 2 2 2 , 5 5 4 2
. 3 0
. 3 7
. 4 0
. 9 U r o l o g y ...................................... 1 7 , 1 3 3 1 , 8 9 1 1
. 9 0
. 2 6
. 1 0
. 7 Otolaryngology

................................. 1 7 , 0 8 0 1 , 9 5 4 1
. 9 0
. 2 6
. 0 0
. 7 General surgery ................................ 1 7 , 0 0 0 2 , 1 5 4 1
. 9 0
. 2 6
. 0 0
. 8 Neurology

.................................... 9 , 6 2 2 9 0 0 1
. 1 0
. 1 3
. 4 0
. 3 All o ther specialties

.............................. 103,974 9,200 1 1 .7 1.0 36.7 3 .2 Professional identity Doctor of medicine

............................... 824,595 27,653 92.7 0 .7 291.3 9 .8 Doctor of osteopathy

............................. 6 5 , 3 8 5 6 , 6 3 6 7
. 3 0
. 7 2 3
. 1 2
. 3 Specialty type 5 P r i m a r y c a r e .................................. 558,402 22,198 62.7 1 .3 197.3 7 .8 S u r g i c a l

..................................... 177,397 10,576 19.9 1 .0 62.7 3 .7 Medical

...................................... 154,181 10,895 17.3 1 .2 54.5 3 .8 Geographic r egion Northeast

.................................... 205,668 14,023 23.1 1 .4 385.2 26.3 Midwest

..................................... 196,749 1 1 ,632 22.1 1 .2 307.0 18.1 South

....................................... 300,665 19,173 33.8 1 .6 297.7 19.0 W e s t
....................................... 186,898 9,744 21.0 1 .1 289.4 15.1 Metropolitan s tatus MSA 6

....................................... 765,191 27,191 86.0 1 .5 338.4 12.0 Non-MSA 6

.................................... 124,790 13,689 14.0 1 .5 222.6 24.4

. . . Category not applicable. 1 V i sit r ates for age, sex, race, and region are based on the July 1 , 2002, set of estimates of the c ivilian noninstitutional population o f t he United S tat es as developed by the Population D ivision, U.S. Census Bureau. These population estimates reflect Census 2000 data and are available from t he U.S Census Bureau. See the ‘ ‘T echnical Notes’ ’ f or more details. 2 2002 population estimates of metropolitan s tatistical area status are based on Census 2000 data and were obtained through the O f fice o f Research and M ethodology and Division of Health Interview S tatistics, National Center for Health Statistics. 3 The population used for t he rate is based on visits by children under 15 years o f age. 4 The population used for t he rate is based on visits by females 15 years o ld and over . 5 Specialty type is defined in table I V o f t he ‘ ‘ T echnical Notes.’ ’ 6 MSA is metropolitan s tatistical area. NOTE: Numbers may not add to totals because of rounding.

# Advance **Data No.**  **346** + **August 26,**  **2004** 15 **T**

**able 2**  **. Number**  **and percent**  **distribution o**  **f o**  **ffice v**  **isits with**  **corresponding standard**  **e rrors,**  **b y**  **selected physician**  **practice characteristics:**  **United S**  **tates, 2002**  Number of Standard Standard visits in error i n Percent error o f Physician of fice characteristics thousands thousands distribution percent A l l v i s i t s ........................................ 889,980 28,1 1 0 100.0
. . . Employment status Owner

......................................... 664,121 29,206 74.6 1 .9 Employee

....................................... 189,987 16,404 21.3 1 .8 C o n t r a c t o r ....................................... 3 5 , 8 7 3 6 , 7 5 8 4
. 0 0
. 8 Ownership Physician/group

.................................... 767,468 27,423 86.2 1 .6 O t h e r h e a l t h c a r e c o r p o r a t i o n ........................... 4 2 , 4 9 7 7 , 6 0 6 4
. 8 0
. 8 Other hospital

..................................... 3 3 , 1 8 8 6 , 5 0 4 3
. 7 0
. 7 Medical/academic health center
.......................... * 1 9 , 7 9 4 6 , 6 3 2 * 2
. 2 0
. 7 HMO 1

.......................................... 1 4 , 8 8 5 4 , 0 2 4 1
. 7 0
. 5 Other 2

......................................... 1 2 , 1 4 9 3 , 5 6 6 1
. 4 0
. 4 Practice s ize S o l o ........................................... 313,795 20,044 35.3 1 .9 2
– 4
........................................... 290,632 18,256 32.7 1 .8 5
– 9
........................................... 180,825 15,433 20.3 1 .5 10–39
.......................................... 8 0 , 7 9 6 1 0 , 8 2 5 9
. 1 1
. 2 4 0 o r m o r e ....................................... * 1 9 , 5 0 5 6 , 5 7 9 * 2
. 2 0
. 7 B l a n k

.......................................... * 4 , 4 2 8 1 , 8 3 3 * 0
. 5 0
. 2 T ype of practice Single-specialty group ................................ 366,676 19,869 41.2 2 .0 Multispecialty group ................................. 209,510 18,294 23.5 1 .8 S o l o ........................................... 313,795 20,044 35.3 1 .9 Of fice t ype P r i v a t e p r a c t i c e .................................... 817,154 28,662 91.8 1 .2 Clinic/urgicenter

................................... 4 6 , 3 8 0 9 , 8 2 7 5
. 2 1
. 1 Other 3

......................................... 2 6 , 4 4 7 4 , 7 3 9 3
. 0 0
. 5

. . . Category not applicable. * F igure does not meet standard o f r eliability or precision.� 1 HMO is health maintenance organization.� 2 Other includes owners such as local government (State, county , or city) and charitable o rganizations.� 3 Other includes the f ollowing of fice t ypes: HMO, non-Federal government clinic, mental health center , f ederally qualified health center , and facil ity practice p lan.� NOTE: Numbers may not add to totals because of rounding.�

# 16 **Advance Data**  **No. 346**  + **August 26,**  **2004 T** 

**able 3**  **. Number**  **, percent**  **distribution, and**  **annual rate**  **of office**  **v isits**  **with corresponding**  **standard errors,**  **b y**  **patient’s age,**  **sex, and**  **race: United**  **S tates,**  **2002** Number of visits Number of Standard Standard per 100 Standard

visits in error i n Percent error o f persons error o f Patient’s age, sex, and race thousands thousands distribution percent per year 1 rate A l l v i s i t s ................................... 889,980 28,1 1 0 100.0
. . . 314.4 9 .9 Age Under 15 years ............................... 159,235 8,449 17.9 0 .8 262.8 13.9

15–24 years ............................... 7 1 , 8 6 5 3 , 6 0 5 8
. 1 0
. 4 181.9 9 .1 25–44 years ............................... 192,359 7,978 21.6 0 .6 232.2 9 .6 45–64 years ............................... 242,142 9,915 27.2 0 .6 365.8 15.0 65–74 years ............................... 109,331 5,361 12.3 0 .4 606.4 29.7 75 years and over ............................ 1 1 5 , 0 4 9 6 , 0 6 6 1 2
. 9 0
. 5 722.2 38.1 Sex and age Female

.................................... 529,075 17,025 59.4 0 .6 364.9 1 1.7

Under 15 years ............................. 7 6 , 3 8 2 4 , 2 8 7 8
. 6 0
. 4 258.1 14.5 15–24 years ............................... 4 4 , 9 0 9 2 , 4 9 4 5
. 0 0
. 3 228.8 12.7 25–44 years ............................... 128,743 5,836 14.5 0 .5 306.3 13.9 45–64 years ............................... 144,205 6,164 16.2 0 .4 422.7 18.1 65–74 years ............................... 6 1 , 8 1 9 3 , 2 5 4 6
. 9 0
. 3 628.1 33.1 75 years and over ............................ 7 3 , 0 1 7 4 , 3 0 5 8
. 2 0
. 4 745.7 44.0 M a l e ..................................... 360,905 13,295 40.6 0 .6 261.4 9 .6

Under 15 years ............................. 8 2 , 8 5 3 4 , 5 5 6 9
. 3 0
. 5 267.2 14.7 15–24 years ............................... 2 6 , 9 5 6 1 , 9 8 9 3
. 0 0
. 2 135.6 10.0 25–44 years ............................... 6 3 , 6 1 6 3 , 6 5 0 7
. 1 0
. 3 155.9 8 .9 45–64 years ............................... 9 7 , 9 3 7 4 , 8 1 1 1 1
. 0 0
. 4 305.3 15.0 65–74 years ............................... 4 7 , 5 1 2 2 , 6 8 6 5
. 3 0
. 2 580.2 32.8 75 years and over ............................ 4 2 , 0 3 2 2 , 3 5 3 4
. 7 0
. 2 684.6 38.3 Race and age 2 W h i t e ..................................... 766,096 26,574 86.1 1 .0 334.6 1 1.6

Under 15 years ............................. 131,023 7,208 14.7 0 .7 282.9 15.6 15–24 years ............................... 6 1 , 0 1 2 3 , 2 9 7 6
. 9 0
. 3 197.5 10.7 25–44 years ............................... 164,890 7,534 18.5 0 .6 248.3 1 1.3 45–64 years ............................... 2 1 1 , 1 6 2 9 , 1 4 5 2 3
. 7 0
. 6 380.7 16.5 65–74 years ............................... 9 5 , 4 6 5 5 , 3 1 1 1 0
. 7 0
. 5 6 1 1
. 4 3 4
. 0 75 years and over ............................ 102,544 5,504 1 1 .5 0.5 720.1 38.7 B l a c k o r A f r i c a n A m e r i c a n ........................ 8 9 , 4 5 5 8 , 1 0 8 1 0
. 1 0
. 9 252.9 22.9

Under 15 years ............................. 1 9 , 8 6 7 2 , 6 9 5 2
. 2 0
. 3 209.4 28.4 15–24 years ............................... 8 , 0 7 1 9 8 5 0
. 9 0
. 1 142.0 17.3 25–44 years ............................... 1 8 , 7 5 0 1 , 8 6 2 2
. 1 0
. 2 181.2 18.0 45–64 years ............................... 2 2 , 4 9 6 2 , 5 9 2 2
. 5 0
. 3 319.2 36.8 65–74 years ............................... 1 0 , 7 3 3 2 , 6 5 9 1
. 2 0
. 3 658.8 163.2 75 years and over ............................ 9 , 5 3 8 2 , 5 9 5 1
. 1 0
. 3 8 1 1
. 7 220.8 All o ther races 2 A s i a n ..................................... 2 6 , 3 4 1 3 , 8 5 1 3
. 0 0
. 4 229.3 33.5 Native Hawaiian o r o ther Pacific Islander

............... 3 , 4 3 0 7 0 8 0
. 4 0
. 1 721.7 148.9 American Indian or Alaska Native

.................... 2 , 2 3 7 4 7 3 0
. 3 0
. 1 8 2
. 9 1 7
. 5 Multiple races ................................ * 2 , 4 2 1 7 4 9 * 0
. 3 0
. 1 *58.6 18.1

. . . Category not applicable. *Figure does not meet standard o f r eliability or precision. 1 V i sit r ates for age, sex, and race are based on the July 1 , 2002, set of estimates of the c ivilian noninstitutional population o f t he United S tates a s dev eloped by the Population D ivision, U.S. Census Bureau. These population estimates reflect Census 2000 data and are available from t he U.S. Census Bureau. See ‘ ‘ T echnical Notes’ ’ f or more d e tails. 2 The race groups, white, b lack or African American, Asian, Native Hawaiian o r o ther Pacific Islander , American Indian or Alaska Native, and multiple r aces, include persons of Hispanic and not Hispanic o rigin. Persons of Hispanic o rigin may be of any race. Starting w ith data year 1999, race-specific estimates have been tabulated according t o 1997 Standards for Federal Data o n Race and Ethnicity and are not strictly comparable w ith estimates for earlier years. However , t he percent of visit r ecords with multiple races indicated i s small and lower than what is typically found for self-reported r ace. See ‘ ‘ T echnical Notes’ ’ f or more details. NOTE: Numbers may not add to totals because of rounding.

# Advance **Data No.**  **346** + **August 26,**  **2004** 17 **T**

**able 4**  **. Number**  **and percent**  **distribution o**  **f o**  **ffice v**  **isits with**  **corresponding standard**  **e rrors,**  **b y**  **selected visit**  **characterstics, according**  **to prior-visit**  **status: United**  **S tates,**  **2002** Prior-visit status All Established New Unknown/ Primary care physician and referral s tatus visits patient patient blank Number of visits in thousands A l l v i s i t s ..................................... 889,980 771,679 108,049 10,252 V i sit t o PCP 1

.................................. 448,679 427,647 19,030 2,002 V i sit t o non-PCP 1

............................... 391,742 308,530 81,124 2,089

Referred b y o ther physician

........................ 122,01 1 71,517 50,070 424 Not referred b y o ther physician

...................... 212,410 189,294 22,330 786 Unknown if referred

............................. 5 7 , 3 2 0 4 7 , 7 1 8 8 , 7 2 4 *879 Unknown if PCP 1 v i s i t
............................. 4 9 , 5 5 9 3 5 , 5 0 3 7 , 8 9 5 * 6 , 1 6 1 Standard e rror i n t housands A l l v i s i t s ..................................... 2 8 , 1 1 0 2 4 , 9 0 6 5 , 9 2 9 2 , 9 6 5 V i sit t o PCP 1

.................................. 2 0 , 7 3 7 1 9 , 7 4 5 1 , 8 9 8 4 1 5 V i sit t o non-PCP 1

............................... 1 7 , 1 3 5 1 3 , 7 7 1 5 , 2 8 9 5 0 9

Referred b y o ther physician

........................ 7 , 3 1 2 4 , 7 1 0 3 , 4 5 2 1 0 8 Not referred b y o ther physician

...................... 1 2 , 9 6 8 1 1 , 2 9 0 3 , 2 8 9 2 0 2 Unknown if referred

............................. 5 , 9 8 9 5 , 6 0 6 1 , 1 0 4 3 9 2 Unknown if PCP 1 v i s i t
............................. 7 , 5 4 7 5 , 9 3 1 1 , 2 9 9 2 , 8 9 3 Percent distribution A l l v i s i t s ..................................... 100.0 100.0 100.0 100.0 V i sit t o PCP 1

.................................. 5 0
. 4 5 5
. 4 1 7
. 6 *19.5 V i sit t o non-PCP 1

............................... 4 4
. 0 4 0
. 0 7 5
. 1 *20.4

Referred b y o ther physician

........................ 1 3
. 7 9
. 3 4 6
. 3 * 4
. 1 Not referred b y o ther physician

...................... 2 3
. 9 2 4
. 5 2 0
. 7 * 7
. 7 Unknown if referred

............................. 6
. 4 6
. 2 8
. 1 * 8
. 6 Unknown if PCP 1 v i s i t
............................. 5
. 6 4
. 6 7
. 3 6 0
. 1 Standard e rror o f percent A l l v i s i t s ..................................... . . . . . . . . . . . . V i sit t o PCP 1

.................................. 1
. 5 1
. 5 1
. 6 6
. 6 V i sit t o non-PCP 1

............................... 1
. 5 1
. 5 2
. 0 7
. 0

Referred b y o ther physician

........................ 0
. 7 0
. 6 2
. 4 1
. 5 Not referred b y o ther physician

...................... 1
. 3 1
. 3 2
. 5 2
. 8 Unknown if referred

............................. 0
. 7 0
. 7 0
. 9 4
. 2 Unknown if PCP 1 v i s i t
............................. 0
. 8 0
. 8 1
. 2 1 1
. 8 * F igure does not meet standard o f r eliability or precision.�

. . . Category not applicable.� 1 PCP is patient’s primary care physician or provider

.� NOTE: Numbers may not add to totals because of rounding.

# 18 **Advance Data**  **No. 346**  + **August 26,**  **2004 T** 

**able 5**  **. Percent**  **distribution o**  **f o**  **ffice v**  **isits with**  **corresponding standard**  **e rrors**  **by physician**  **specialty ,**  **according to**  **primary c**  **are physician**  **and referral**  **s tatus:**  **United S**  **tates 2002**  V i sit t o non-PCP 2 Referred Not referred by other physician Physican specialty T o tal Vi s i t t o PCP 1 by other physician Unknown if referred Unknown if PCP 1 visit Percent distribution A l l v i s i t s ................................... 100.0 50.4 13.7 23.9 6 .4 5.6 General and family practice

....................... 100.0 84.1 * 2.8 6 .5 1.2 5 .5 Internal medicine

.............................. 100.0 82.3 2 .9 *6.0 *1.9 *7.0 Pediatrics

.................................. 100.0 88.2 2 .0 5.5 2 .5 1.9 Obstetrics and gynecology

........................ 100.0 15.3 10.0 54.0 6 .5 14.1 Ophthalmology

............................... 100.0 *2.0 20.7 61.7 1 1.9 *3.7 Orthopedic surgery ............................. 100.0 *5.3 45.5 36.9 9 .8 * D e r m a t o l o g y ................................. 100.0 * 18.9 58.7 18.6 *3.7 Cardiovascular diseases

......................... 100.0 * 15.9 64.6 14.3 *4.7 Psychiatry

.................................. 100.0 13.4 40.2 40.6 4 .9 * General surgery .............................. 100.0 *8.1 41.0 40.2 9 .0 * Otolaryngology

............................... 100.0 * 39.8 42.4 13.9 3 .3 U r o l o g y .................................... 100.0 *3.8 50.9 33.9 10.2 * Neurology

.................................. 100.0 *2.6 55.2 29.6 10.3 2 .2 All o ther specialties

............................ 100.0 13.1 27.7 34.2 17.1 *7.9 Standard e rror o f percent A l l v i s i t s ................................... . . . 1
. 5 0
. 7 1
. 3 0
. 7 0
. 8 General and family practice

....................... . . . 2
. 2 0
. 9 1
. 4 0
. 3 1
. 1 Internal medicine

.............................. . . . 3
. 8 0
. 8 2
. 2 1
. 0 2
. 5 Pediatrics

.................................. . . . 1
. 8 0
. 6 1
. 3 0
. 7 0
. 4 Obstetrics and gynecology

........................ . . . 3
. 3 2
. 2 5
. 1 1
. 9 3
. 7 Ophthalmology

............................... . . . 1
. 0 4
. 1 5
. 0 2
. 8 1
. 8 Orthopedic surgery ............................. . . . 2
. 0 5
. 1 4
. 9 2
. 2
. . . D e r m a t o l o g y ................................. . . . . . . 3
. 1 5
. 4 5
. 0 1
. 8 Cardiovascular diseases

......................... . . . . . . 4
. 3 6
. 0 3
. 6 1
. 7 Psychiatry

.................................. . . . 4
. 0 5
. 8 5
. 6 1
. 0
. . . General surgery .............................. . . . 3
. 0 5
. 1 4
. 6 2
. 2
. . . Otolaryngology

............................... . . . . . . 3
. 9 4
. 5 2
. 7 1
. 0 U r o l o g y .................................... . . . 2
. 6 4
. 5 4
. 4 3
. 0
. . . Neurology

.................................. . . . 0
. 9 3
. 8 3
. 6 2
. 5 0
. 5 All o ther specialties

............................ . . . 3
. 1 3
. 8 4
. 2 4
. 2 3
. 9 * F igure does not meet standard o f r eliability or precision.�

. . . Category not applicable.� 1 PCP is patient’s primary care physician or provider

.� 2 Referral s tatus only asked for v isits to nonprimary care physicians or providers.� NOTE: Numbers may not add to totals because of rounding.

# Advance **Data No.**  **346** + **August 26,**  **2004** 19 **T**

**able 6**  **. Number**  **and percent**  **distribution o**  **f o**  **ffice v**  **isits with**  **corresponding standard**  **e rrors,**  **b y**  **c ontinuity-of-care**  **visit characteristics**  **according to**  **specialty type:**  **United S**  **tates, 2002**  Specialty type Specialty type All Primary All Primary Continuity-of-care v isit characteristics specialties care Surgical Medical specialties care Surgical Medical Number of visits in thousands Standard e rror i n t housands A l l v i s i t s ................................. 889,980 558,402 177,397 154,181 28,1 1 0 22,198 10,576 10,895 Prior-visit status and number of visits in last 12 months Established patient

........................... 771,679 508,721 139,308 123,651 24,906 20,557 8,546 9,262

None

.................................. 5 6 , 0 8 0 3 3 , 2 0 4 1 3 , 6 4 0 9 , 2 3 6 3 , 7 9 7 3 , 2 2 5 1 , 3 2 0 1 , 1 0 3 1
– 2 v i s i t s ............................... 245,048 151,762 57,049 36,237 10,461 8,043 3,958 3,510 3
– 5 v i s i t s ............................... 225,822 155,650 37,519 32,654 9,944 8,643 2,781 3,232 6 o r m o r e v i s i t s ........................... 201,998 136,529 24,844 40,625 10,909 8,578 2,356 5,939 Unknown

............................... 4 2 , 7 3 1 3 1 , 5 7 6 6 , 2 5 5 * 4 , 8 9 8 5 , 1 3 8 4 , 6 7 2 1 , 1 9 7 1 , 6 9 5 N e w p a t i e n t
............................... 108,049 42,481 36,507 29,061 5,929 3,940 2,882 2,795 Unknown if patient previously seen ................. 1 0 , 2 5 2 * 7 , 2 0 0 1 , 5 8 2 1 , 4 7 0 2 , 9 6 5 2 , 9 2 6 2 7 8 Do other physicians share care f or this problem? Y

e s .................................... 202,393 102,662 55,996 43,736 1 1 ,317 8,019 5,298 4,721 N o ..................................... 570,326 384,892 104,432 81,002 22,255 18,556 7,939 8,133 Unknown/blank

............................. 1 1 7 , 2 6 1 7 0 , 8 4 8 1 6 , 9 6 9 2 9 , 4 4 4 1 2 , 1 5 5 9 , 6 2 6 2 , 1 0 6 6 , 7 7 8 Episode of care Initial v isit for p roblem

......................... 273,910 189,092 47,167 37,651 10,771 9,294 3,384 3,494 Followup visits for p roblem

...................... 401,767 196,012 103,529 102,227 17,1 1 7 12,353 6,580 8,131 Unknown/blank

............................. 6 9 , 4 5 2 4 3 , 0 4 6 1 7 , 3 8 4 9 , 0 2 2 5 , 3 1 8 4 , 4 9 1 2 , 2 3 7 1 , 1 9 6 Not applicable ( preventive care v isit) 1

............... 144,851 130,253 9,316 5,282 8,045 7,988 1,254 1,056 Percent distribution S tandard e rror o f percent A l l v i s i t s ................................. 100.0 100.0 100.0 100.0
. . . . . . . . . . . . Prior-visit status and number of visits in last 12 months Established patient

........................... 8 6
. 7 9 1
. 1 7 8
. 5 8 0
. 2 0
. 6 0
. 8 1
. 1 1
. 4

None

.................................. 6
. 3 5
. 9 7
. 7 6
. 0 0
. 4 0
. 6 0
. 6 0
. 6 1
– 2 v i s i t s ............................... 2 7
. 5 2 7
. 2 3 2
. 2 2 3
. 5 0
. 8 1
. 0 1
. 0 1
. 7 3
– 5 v i s i t s ............................... 2 5
. 4 2 7
. 9 2 1
. 1 2 1
. 2 0
. 7 0
. 9 0
. 9 1
. 6 6 o r m o r e v i s i t s ........................... 2 2
. 7 2 4
. 4 1 4
. 0 2 6
. 3 1
. 0 1
. 2 1
. 1 3
. 0 Unknown

............................... 4
. 8 5
. 7 3
. 5 * 3
. 2 0
. 6 0
. 8 0
. 7 1
. 1 N e w p a t i e n t
............................... 1 2
. 1 7
. 6 2 0
. 6 1 8
. 8 0
. 5 0
. 6 1
. 1 1
. 4 Unknown if patient previously seen ................. 1
. 2 * 1
. 3 0
. 9 1
. 0 0
. 3 0
. 5 0
. 2 0
. 3 Do other physicians share care f or this problem? Y

e s .................................... 2 2
. 7 1 8
. 4 3 1
. 6 2 8
. 4 1
. 1 1
. 3 2
. 4 2
. 8 N o ..................................... 6 4
. 1 6 8
. 9 5 8
. 9 5 2
. 5 1
. 4 1
. 8 2
. 5 3
. 8 Unknown/blank

............................. 1 3
. 2 1 2
. 7 9
. 6 1 9
. 1 1
. 3 1
. 6 1
. 1 4
. 0 Episode of care Initial v isit for p roblem

......................... 3 0
. 8 3 3
. 9 2 6
. 6 2 4
. 4 0
. 7 1
. 1 1
. 1 1
. 6 Followup visits for p roblem

...................... 4 5
. 1 3 5
. 1 5 8
. 4 6 6
. 3 1
. 1 1
. 5 1
. 4 1
. 8 Unknown/blank

............................. 7
. 8 7
. 7 9
. 8 5
. 9 0
. 6 0
. 8 1
. 1 0
. 7 Not applicable ( preventive care v isit) 1

............... 1 6
. 3 2 3
. 3 5
. 3 3
. 4 0
. 8 1
. 1 0
. 6 0
. 6

. . . Category not applicable. * F igure does not meet standard o f r eliability or precision.� 1 Preventive care i ncludes routine p renatal, general medical, well-baby , and screening or insurance examinations.� NOTE: Numbers may not add to totals because of rounding. 4 0 4

# 20 **Advance Data**  **No. 346**  + **August 26,**  **2004 T** 

**able 7**  **. Number**  **and percent**  **distribution o**  **f o**  **ffice v**  **isits with**  **corresponding standard**  **e rrors,**  **b y**  **p rimary**  **expected source**  **of payment:**  **United S**  **tates, 2002**  Number of Standard Standard visits in error i n Percent error o f Primary expected source of payment thousands thousands distribution percent A l l v i s i t s ........................................ 889,980 28,1 1 0 100.0
. . . Private i nsurance ................................... 525,520 19,927 59.0 1 .1 Medicare

........................................ 188,207 9,642 21.1 0 .8 Medicaid/SCHIP 1

................................... 6 7 , 1 1 0 5 , 1 6 8 7
. 5 0
. 6 S e l f
- p a y ........................................ 3 9 , 5 2 6 4 , 1 1 1 4
. 4 0
. 4 W o rkers’ compensation

............................... 1 4 , 6 5 8 2 , 5 6 1 1
. 6 0
. 3 No charge/charity

.................................. 2 , 4 8 5 5 2 6 0
. 3 0
. 1 O t h e r .......................................... 2 1 , 4 5 6 4 , 2 5 8 2
. 4 0
. 5 Unknown/blank

.................................... 3 1 , 0 1 8 4 , 2 5 4 3
. 5 0
. 5

. . . Category not applicable.� 1 SCHIP i s S tate Children’s Health Insurance Program.� NOTE: Numbers may not add to totals because of rounding.�


### T

**able 8**  **. Number**  **and percent**  **distribution o**  **f o**  **ffice v**  **isits with**  **corresponding standard**  **e rrors,**  **b y**  **patient’s principal**  **reason for**  **v isit:**  **United S**  **tates, 2002**  Number of Standard Standard visits in error i n Percent error o f Principal reason for v isit and R V C code 1 thousands thousands distribution percent A l l v i s i t s .................................................... 889,980 28,1 1 0 100.0
. . . Symptom module

....................................... S001–S999 452,280 16,678 50.8 1 .0

General symptoms
.................................... S001–S099 58,080 4,831 6.5 0 .5 Symptoms referable t o psychological/mental disorders

.............. S100–S199 26,279 2,009 3.0 0 .2 Symptoms referable t o t he nervous system (excluding sense organs)

..... S200–S259 22,687 1,496 2.5 0 .1 Symptoms referable t o t he cardiovascular/lymphatic system
........... S260–S299 4,476 661 0.5 0 .1 Symptoms referable t o t he eyes and ears ...................... S300–S399 48,703 3,31 1 5 .5 0.3 Symptoms referable t o t he respiratory system
................... S400–S499 93,529 5,654 10.5 0 .5 Symptoms referable t o t he digestive systems
.................... S500–S639 35,136 2,354 3.9 0 .2 Symptoms referable t o t he genitourinary system
.................. S640–S829 30,769 1,797 3.5 0 .2 Symptoms referable t o t he skin, hair , and nails

................... S830–S899 43,690 3,000 4.9 0 .3 Symptoms referable t o t he musculoskeletal system
................ S900–S999 88,933 6,360 10.0 0 .6 Disease module

....................................... D001–D999 100,526 5,838 1 1 .3 0.6 Diagnostic/screening and preventive module

...................... X100–X599 164,643 8,994 18.5 0 .8 T r eatment module

....................................... T100–T899 1 12,807 8,930 12.7 0 .9 Injuries and adverse ef fects module

............................ J001–J999 22,445 1,788 2.5 0 .2 T est results module

..................................... R100–R700 22,078 2,106 2.5 0 .2 Administrative module

.................................... A100–A140 6,845 1,395 0.8 0 .2 Other 2

............................................. U990–U999 8,357 1,147 0.9 0 .1

. . . Category not applicable. 1 Based on A Reason for V isit Classification f or Ambulatory Care (R VC) (6). 2 Includes problems and complaints not elsewhere c lassified, entries o f ‘ ‘none,’ ’ blanks, and illegible entries. NOTE: Numbers may not add to totals because of rounding.**T able** **9 .** **Number and** **percent distribution** **o f** **o ffice** **v isits** **with corresponding** **standard e** **rrors, b** **y t** **he 20** **principal reasons** **for v** **isit most** **frequently m** **entioned by** **patients, according** **to patient’s** **sex: United** **S tates,** **2002**Patient’ssexFemale2Male3NumberofStandardStandardStandardStandardvisitsinerrorinPercenterrorofPercenterrorofPercenterrorofPrincipalreasonforvisitandRVCcode1thousandsthousandsdistributionpercentdistributionpercentdistributionpercentAllvisits..........................................889,98028,110100.0...100.0...100.0...Generalmedicalexamination..........................X10064,7264,6677.30.46.80.57.90.5Progressvisit,nototherwisespecified.....................T80040,9835,4144.60.63.90.55.60.7Cough........................................S44028,4692,0863.20.23.10.23.40.3Postoperativevisit.................................T20522,0831,6482.50.22.40.22.60.2Prenatalexamination,routine..........................X20519,5822,5522.20.33.70.5......Symptomsreferabletothroat..........................S45518,5151,5352.10.22.20.22.00.2Hypertension....................................D51017,1952,3151.90.32.00.41.80.2Kneesymptoms..................................S92514,8031,6111.70.21.70.21.70.2Wellbabyexamination..............................X10514,2931,4401.60.21.40.21.90.2Medication,otherandunspecifiedkinds....................T11514,0761,6381.60.21.60.21.60.2Stomachpain,cramps,andspasms......................S54513,5471,4061.50.21.70.21.20.2Earache,orearinfection.............................S35513,1601,1271.50.11.40.11.50.2Backsymptoms...................................S90512,9021,2981.40.11.40.11.60.2Visiondysfunctions................................S30512,8971,6631.40.21.40.21.50.2Bloodpressuretest................................X32012,6302,0961.40.21.50.31.30.2Fever.........................................S01012,2581,2481.40.11.20.11.70.2Nasalcongestion..................................S40012,1491,5701.40.21.20.21.50.2Skinrash.......................................S86011,8871,0611.30.11.20.11.60.2Chestpainandrelatedsymptoms(notreferabletobodysystem)....S050*11,1893,546*1.30.4*1.40.51.10.3Diabetesmellitus..................................D20511,1891,3781.30.11.00.11.60.2Allotherreasons.....................................511,44617,42057.50.857.80.957.01.0...Categorynotapplicable.*Figuredoesnotmeetstandardofreliabilityorprecision.1BasedonAReasonforVisitClassificationforAmbulatoryCare(RFV)(6).2Basedon529,075,000visitsmadebyfemales.3Basedon360,905,000visitsmadebymales.NOTE:Numbersmaynotaddtototalsbecauseofrounding.

**Advance Data**  **No. 346**  + **August 26,**  **2004** 21�

# 22 **Advance Data**  **No. 346**  + **August 26,**  **2004 T** 

**able 10.**  **Number and**  **percent distribution**  **o f**  **o ffice**  **v isits**  **with corresponding**  **standard e**  **rrors by**  **major reason**  **for t**  **his v**  **isit, according**  **to patient’s**  **age, sex,**  **and race:**  **United S**  **tates, 2002**  Major reason for v isit Chronic Chronic Acute problem, problem, Pre- or Preventive Unknown/ Patient’ s age, sex, and race T o tal problem routine flare-up post-surgery care 1 blank Number of visits in thousands A l l v i s i t s ................................. 889,980 323,541 264,452 76,383 46,153 144,851 34,601 Age Under 15 years ............................. 159,235 82,771 17,133 7,758 2,552 43,557 5,463 15–24 years ............................... 7 1 , 8 6 5 3 2 , 1 9 1 1 3 , 0 0 4 4 , 9 0 6 2 , 9 5 7 1 5 , 8 7 2 2 , 9 3 4 25–44 years ............................... 192,359 71,598 46,366 16,383 10,606 39,865 7,541 45–64 years ............................... 242,142 77,842 88,022 25,908 13,21 1 27,316 9,844 65–74 years ............................... 109,331 27,665 47,987 10,702 7,636 10,642 4,698 75 years and over ........................... 1 1 5 , 0 4 9 3 1 , 4 7 4 5 1 , 9 4 1 1 0 , 7 2 6 9 , 1 9 1 7 , 5 9 8 4 , 1 2 0 Sex Female

.................................. 529,075 185,407 153,009 46,087 27,177 97,008 20,387 M a l e ................................... 360,905 138,134 1 1 1 ,443 30,296 18,976 47,843 14,214 Race 2 W h i t e ................................... 766,096 280,834 226,296 68,513 41,432 120,074 28,947 B l a c k

................................... 8 9 , 4 5 5 3 1 , 1 6 5 2 7 , 9 6 1 5 , 3 5 8 3 , 7 6 3 1 7 , 5 0 2 3 , 7 0 6 O t h e r ................................... 3 4 , 4 2 9 1 1 , 5 4 2 1 0 , 1 9 4 2 , 5 1 2 9 5 8 7 , 2 7 5 * 1 , 9 4 8 Standard e rror i n t housands A l l v i s i t s ................................. 2 8 , 1 1 0 1 2 , 0 8 9 1 3 , 4 2 4 5 , 7 2 0 3 , 1 0 7 8 , 0 4 5 5 , 0 9 2 Age Under 15 years ............................. 8 , 4 4 9 5 , 5 4 1 2 , 1 6 5 9 8 3 4 1 1 3 , 2 0 8 1 , 1 4 3 15–24 years ............................... 3 , 6 0 5 1 , 9 6 0 1 , 7 0 0 7 0 1 4 0 8 1 , 6 6 4 6 8 3 25–44 years ............................... 7 , 9 7 8 3 , 8 8 5 3 , 0 7 7 1 , 5 7 1 8 7 8 3 , 4 1 4 1 , 2 5 2 45–64 years ............................... 9 , 9 1 5 3 , 6 6 4 5 , 0 3 7 2 , 5 0 7 1 , 1 0 6 2 , 4 4 6 1 , 6 9 9 65–74 years ............................... 5 , 3 6 1 1 , 7 9 3 3 , 2 1 5 1 , 0 7 8 8 1 2 1 , 5 8 6 1 , 0 9 5 75 years and over ........................... 6 , 0 6 6 2 , 0 7 8 3 , 9 5 7 1 , 0 0 9 1 , 0 3 4 1 , 0 8 4 8 2 1 Sex Female

.................................. 1 7 , 0 2 5 7 , 2 4 0 8 , 7 2 3 3 , 5 5 2 1 , 8 9 3 5 , 8 7 9 3 , 4 2 4 M a l e ................................... 1 3 , 2 9 5 5 , 9 2 1 5 , 8 2 2 2 , 7 0 1 1 , 5 4 7 3 , 6 0 1 1 , 9 8 9 Race 2 W h i t e ................................... 2 6 , 5 7 4 1 1 , 1 5 5 1 1 , 9 2 5 5 , 4 0 3 2 , 8 9 5 7 , 0 9 6 4 , 4 7 6 B l a c k

................................... 8 , 1 0 8 2 , 8 1 9 4 , 5 0 3 7 2 9 4 5 9 2 , 4 5 0 9 2 3 O t h e r ................................... 4 , 9 2 6 1 , 2 6 7 2 , 4 5 0 5 0 2 2 0 2 1 , 5 7 5 6 3 3 Percent distribution A l l v i s i t s ................................. 100.0 36.4 29.7 8 .6 5.2 16.3 3 .9 Age Under 15 years ............................. 100.0 52.0 10.8 4 .9 1.6 27.4 3 .4 15–24 years ............................... 100.0 44.8 18.1 6 .8 4.1 22.1 4 .1 25–44 years ............................... 100.0 37.2 24.1 8 .5 5.5 20.7 3 .9 45–64 years ............................... 100.0 32.1 36.4 10.7 5 .5 1 1 .3 4.1 65–74 years ............................... 100.0 25.3 43.9 9 .8 7.0 9 .7 4.3 75 years and over ........................... 100.0 27.4 45.1 9 .3 8.0 6 .6 3.6 Sex Female

.................................. 100.0 35.0 28.9 8 .7 5.1 18.3 3 .9 M a l e ................................... 100.0 38.3 30.9 8 .4 5.3 13.3 3 .9 Race 2 W h i t e ................................... 100.0 36.7 29.5 8 .9 5.4 15.7 3 .8 B l a c k

................................... 100.0 34.8 31.3 6 .0 4.2 19.6 4 .1 O t h e r ................................... 100.0 33.5 29.6 7 .3 2.8 21.1 * 5.7 See footnotes at end of table.

# Advance **Data No.**  **346** + **August 26,**  **2004** 23 **T**

**able 10.**  **Number and**  **percent distribution**  **o f**  **o ffice**  **v isits**  **with corresponding**  **standard e**  **rrors by**  **major reason**  **for t**  **his v**  **isit, according**  **to patient’s**  **age, sex,**  **and race:**  **United S**  **tates, 2002—Con.**  Major reason for v isit Chronic Chronic Acute problem, problem, Pre- or Preventive Unknown/ Patient’ s age, sex, and race T o tal problem routine flare-up post-surgery care 1 blank Standard e rror o f percent A l l v i s i t s ................................. . . . 0
. 8 1
. 1 0
. 5 0
. 3 0
. 8 0
. 6 Age Under 15 years ............................. . . . 1
. 9 1
. 2 0
. 6 0
. 3 1
. 4 0
. 7 15–24 years ............................... . . . 2
. 2 2
. 0 0
. 9 0
. 5 1
. 9 0
. 9 25–44 years ............................... . . . 1
. 3 1
. 4 0
. 7 0
. 5 1
. 5 0
. 6 45–64 years ............................... . . . 0
. 9 1
. 4 0
. 9 0
. 4 0
. 9 0
. 7 65–74 years ............................... . . . 1
. 2 2
. 0 0
. 9 0
. 7 1
. 3 1
. 0 75 years and over ........................... . . . 1
. 4 1
. 8 0
. 8 0
. 8 0
. 9 0
. 7 Sex Female

.................................. . . . 0
. 9 1
. 3 0
. 6 0
. 3 0
. 9 0
. 6 M a l e ................................... . . . 1
. 0 1
. 2 0
. 6 0
. 4 0
. 8 0
. 5 Race 2 W h i t e ................................... . . . 0
. 9 1
. 1 0
. 6 0
. 3 0
. 8 0
. 6 B l a c k

................................... . . . 2
. 6 3
. 2 0
. 8 0
. 6 1
. 9 0
. 9 Other 2

.................................. . . . 3
. 2 3
. 6 1
. 4 0
. 6 2
. 5 1
. 9 * F igure does not meet standard o f r eliability or precision.

. . . Category not applicable. 1 Preventive care i ncludes prenatal, general medical, well-baby , and screening or insurance examinations. 2 Other race includes visits by Asians, Native Hawaiians or other Pacific Islanders, American Indians or Alaska Natives, and multiple races. All r ace c ategories i nclude visits by persons of Hispanic and not Hispanic o rigin. Persons of Hispanic o rigin may be of any race. Starting w ith data year 1999, race-specific estimates have been tabulated acco rding t o 1997 Standards for Federal Data o n Race and Ethnicity and are not strictly comparable w ith estimates for earlier years. However , t he percent of visit r ecords with multiple races indica ted i s small and lower than what is typically found for self-reported r ace. See ‘ ‘ T echnical Notes’ ’ f or more details. NOTE: Numbers may not add to totals because of rounding.

# 24 **Advance Data**  **No. 346**  + **August 26,**  **2004 T** 

**able 1**  **1. Number**  **, percent**  **distribution, and**  **annual rate**  **of preventive**  **care o**  **ffice v**  **isits and**  **percent of**  **visits to**  **primary care**  **specialists with**  **corresponding standard**  **e rrors,**  **b y**  **selected patient**  **and visit**  **characteristics: United**  **S tates,**  **2002** Number of Number of Standard Standard visits per Standard Percent of preventive Standard

visits in error i n Percent error o f 100 persons error o f care v isits made to error o f Patient and visit characteristics thousands thousands distribution percent per year 1 rate primary care specialists percent All p reventive care v isits 2

.................. 144,851 8,045 100.0
. . . 51.2 2 .8 89.9 1 .2 Age Under 15 years ........................ 4 3 , 5 5 7 3 , 2 0 8 3 0
. 1 2
. 0 7 1
. 9 5
. 3 9 5
. 8 1
. 6 15–24 years .......................... 1 5 , 8 7 2 1 , 6 6 4 1 1
. 0 1
. 0 4 0
. 2 4
. 2 9 6
. 0 1
. 1 25–44 years .......................... 3 9 , 8 6 5 3 , 4 1 4 2 7
. 5 1
. 6 4 8
. 1 4
. 1 9 4
. 2 1
. 1 45–64 years .......................... 2 7 , 3 1 6 2 , 4 4 6 1 8
. 9 1
. 2 4 1
. 3 3
. 7 8 2
. 7 2
. 6 65–74 years .......................... 1 0 , 6 4 2 1 , 5 8 6 7
. 3 0
. 9 5 9
. 0 8
. 8 7 4
. 3 4
. 8 75 years and over ...................... 7 , 5 9 8 1 , 0 8 4 5
. 2 0
. 7 4 7
. 7 6
. 8 6 9
. 0 5
. 5 Sex and age Female

............................. 9 7 , 0 0 8 5 , 8 7 9 6 7
. 0 1
. 7 6 6
. 9 4
. 1 9 1
. 6 1
. 2

Under 15 years ...................... 2 1 , 1 0 6 1 , 6 1 8 1 4
. 6 1
. 0 7 1
. 3 5
. 5 9 5
. 2 1
. 9 15–24 years ........................ 1 2 , 6 0 6 1 , 4 9 4 8
. 7 0
. 9 6 4
. 2 7
. 6 9 6
. 5 1
. 2 25–44 years ........................ 3 4 , 0 0 3 3 , 1 3 3 2 3
. 5 1
. 6 8 0
. 9 7
. 5 9 5
. 6 1
. 2 45–64 years ........................ 1 8 , 4 7 1 1 , 8 8 6 1 2
. 8 1
. 0 5 4
. 1 5
. 5 8 6
. 1 2
. 6 65–74 years ........................ 5 , 8 5 3 7 3 5 4
. 0 0
. 4 5 9
. 5 7
. 5 7 7
. 7 4
. 2 75 years and over ..................... 4 , 9 6 8 8 9 0 3
. 4 0
. 6 5 0
. 7 9
. 1 7 2
. 9 6
. 0 M a l e .............................. 4 7 , 8 4 3 3 , 6 0 1 3 3
. 0 1
. 7 3 4
. 6 2
. 6 8 6
. 5 1
. 8

Under 15 years ...................... 2 2 , 4 5 1 1 , 8 6 5 1 5
. 5 1
. 2 7 2
. 4 6
. 0 9 6
. 3 1
. 5 15–24 years ........................ 3 , 2 6 6 4 2 7 2
. 3 0
. 3 1 6
. 4 2
. 1 9 4
. 0 2
. 4 25–44 years ........................ 5 , 8 6 2 1 , 0 0 0 4
. 0 0
. 6 1 4
. 4 2
. 5 8 6
. 2 3
. 6 45–64 years ........................ 8 , 8 4 4 1 , 1 4 0 6
. 1 0
. 7 2 7
. 6 3
. 6 7 5
. 6 4
. 6 65–74 years ........................ 4 , 7 8 9 1 , 0 6 5 3
. 3 0
. 7 5 8
. 5 1 3
. 0 7 0
. 1 7
. 5 75 years and over ..................... 2 , 6 3 0 4 6 7 1
. 8 0
. 3 4 2
. 8 7
. 6 6 1
. 5 8
. 1 Race W h i t e .............................. 120,074 7,096 82.9 1 .8 52.5 3 .1 89.2 1 .2 Black/African American

................... 1 7 , 5 0 2 2 , 4 5 0 1 2
. 1 1
. 5 4 9
. 5 6
. 9 9 3
. 4 3
. 2 Other 3

............................. 7 , 2 7 5 1 , 5 7 5 5
. 0 1
. 1 3 8
. 7 8
. 4 9 3
. 6 2
. 1 Primary expected source of payment Private i nsurance ....................... 9 7 , 3 4 8 6 , 3 8 5 6 7
. 2 1
. 9 4 8
. 9 3
. 2 9 2
. 2 1
. 2 Medicaid/SCHIP 4

....................... 1 7 , 8 7 2 1 , 8 0 9 1 2
. 3 1
. 2 5 3
. 8 5
. 4 9 4
. 6 1
. 7 Medicare

............................ 1 4 , 7 1 2 1 , 6 5 7 1 0
. 2 1
. 0 3 8
. 3 4
. 3 7 3
. 0 4
. 1 Self-pay/charity/no charge

................. 5 , 8 3 4 1 , 1 8 6 4
. 0 0
. 8 1 3
. 4 2
. 7 8 5
. 6 4
. 3 Other 5

............................. 9 , 0 8 5 1 , 7 8 2 6
. 3 1
. 2
. . . . . . 8 6
. 1 5
. 3

. . . Category not applicable. 1 V i sit r ates for age, sex, and race are based on U.S. Census Bureau estimates of the c ivilian noninstitutional population o f t he United S tates a s o f July 1, 2001. These population estimates reflect Census 2000 and are available from t he U.S Census Bureau. See ‘ ‘ T echnical Notes’ ’ f or more detail. V i sit r ates by expected source of payment are based o n Current Population Survey estimates on health insurance coverage (Mills, B

. Health Insurance Coverage: 2001 Current Population Reports P60–220 September 2002.) 2 Preventive care i ncludes prenatal, general medical, well-baby , and screening or insurance examinations. 3 Other race includes visits by Asian, Native Hawaiian o r o ther Pacific Islander , American Indian or Alaska Native, and multiple races. All r ace catego ries i nclude visits by persons of Hispanic o rigin and not Hispanic o rigin. Persons of Hispanic o rigin may be of any race. Starting w ith data year 1999, race-specific estimates have been tabulated acco rding t o 1997 Standards for Federal Data o n Race and Ethnicity and are not strictly comparable w ith estimates for earlier years. However , t he percent of visit r ecords with multiple races indica ted i s small and lower than what is typically found for self-reported r ace. See ‘ ‘ T echnical Notes’ ’ f or more details.’ ’ 4 SCHIP i s S tate Children’s Health Insurance Program. 5 Other includes W o rkers’ Compensation, unknown/blank, and payments not classified e lsewhere.

# Advance **Data No.**  **346** + **August 26,**  **2004** 25 **T**

**able 12.**  **Number and**  **percent distribution**  **o f**  **o ffice**  **v isits**  **with corresponding**  **standard errors,**  **b y**  **physician’s p**  **rimary diagnosis:**  **United S**  **tates, 2002**  Number of Standard Standard visits in error i n Percent error o f Major disease category and ICD–9–CM code range 1 thousands thousands distribution percent A l l v i s i t s ............................................... 889,980 28,1 1 0 100.0
. . . Infectious and parasitic diseases

.......................... 001–139 24,431 1,740 2.7 0 .2 Neoplasms

........................................ 140–239 25,321 2,477 2.8 0 .3 Endocrine, nutritional, metabolic diseases, immunity disorders

........ 240–279 52,672 5,021 5.9 0 .5 Mental disorders

.................................... 290–319 40,016 3,482 4.5 0 .4 Diseases of the nervous system and sense organs ............... 320–389 79,417 5,006 8.9 0 .5 Diseases of the c irculatory system
......................... 390–459 80,092 5,593 9.0 0 .5 Diseases of the r espiratory system
......................... 460–519 1 12,107 7,239 12.6 0 .7 Diseases of the d igestive system
.......................... 520–579 30,132 2,287 3.4 0 .2 Diseases of the genitourinary system
....................... 580–629 42,706 2,524 4.8 0 .3 Diseases of the skin and subcutaneous tissue

.................. 680–709 42,743 2,910 4.8 0 .3 Diseases of the musculoskeletal and connective tissue

............ 710–739 66,575 5,370 7.5 0 .5 Symptoms, signs, and ill-defined conditions

................... 780–799 55,674 2,862 6.3 0 .2 Injury and poisoning

.................................. 800–999 53,143 3,650 6.0 0 .4 Supplementary c lassification

............................. V01-V82 146,162 7,272 16.4 0 .7 All o ther diagnoses 2

........................................ 1 5 , 7 8 7 1 , 2 3 5 1
. 8 0
. 1 Unknown 3

.............................................. 2 3 , 0 0 2 4 , 2 5 6 2
. 6 0
. 5

. . . Category not applicable. 1 Based on the International Classification o f D iseases, 9th Revision, Clinical Modification (ICD–9–CM) (7). 2 Includes diseases of the b lood and blood-forming o rgans (280–289); complications of pregnancy , childbirth, and the puerperium ( 630–677); congeni tal anomalies (740–759); certain conditions originating i n t he perinatal period ( 760–779). 3 Includes blank diagnoses, uncodable d iagnoses, and illegible d iagnoses. NOTE: Numbers may not add to totals because of rounding.**T able** **13. Number** **and percent** **distribution o** **f o** **ffice visits** **with corresponding** **standard errors,** **b y** **selected primary** **d iagnosis** **g roups,** **according to** **p atient’s** **sex: United** **S tates,** **2002**

26�Patient’ssexFemale2Male3NumberofStandardStandardStandardStandardvisitsinerrorinPercenterrorofPercenterrorofPercenterrorofPrimarydiagnosisgroupandICD–9–CMcodes1thousandsthousandsdistributionpercentdistributionpercentdistributionpercentAllvisits.................................................889,98028,110100.0...100.0...100.0...Essentialhypertension......................................40148,1804,6585.40.55.40.55.40.6Routineinfantorchildhealthcheck.............................V20.235,9353,0154.00.33.20.35.20.5Acuteupperrespiratoryinfections,excludingpharyngitis........460–461,463–46630,1412,2403.40.23.10.33.70.3Diabetesmellitus..........................................25024,8772,6702.80.32.30.23.50.4Arthropathiesandrelateddisorders...........................710–71923,7252,2052.70.22.80.32.40.2Generalmedicalexamination..................................V7022,3623,2262.50.32.50.42.60.5Spinaldisorders.......................................720–72420,4442,7172.30.32.30.32.30.3Rheumatism,excludingback...............................725–72917,7661,7922.00.21.90.22.10.3Normalpregnancy.........................................V2217,5852,3542.00.33.30.4*...OtitismediaandEustachiantubedisorders......................381–38216,7021,5091.90.21.60.22.20.2Malignantneoplasms..............................140–208,230–23415,6512,1581.80.21.50.32.10.2Chronicsinusitis..........................................47314,1971,1701.60.11.60.21.60.2Allergicrhinitis...........................................47714,1013,6731.60.41.70.41.40.4Asthma................................................49312,6921,9061.40.21.50.31.30.2Gynecologicalexamination...................................V72.311,8831,5071.30.22.20.3*...Disorderoflipoidmetabolism..................................27211,7671,4361.30.21.10.21.60.3Heartdisease,excludingischemic....391–392.0,393–398,402,404,415–416,420–42911,6701,1351.30.11.20.11.50.2Ischemicheartdisease..................................410–414.910,9701,2751.20.10.80.11.90.2Acutepharyngitis..........................................46210,0901,0661.10.11.10.11.20.2Followupexamination.......................................V679,9951,4211.10.21.00.21.20.2Allotherdiagnoses..........................................509,24817,58257.20.957.70.956.51.0...Categorynotapplicable.*Figuredoesnotmeetstandardofreliabilityorprecision.�1BasedontheInternationalClassificationofDiseases,9thRevision,ClinicalModification(ICD–9–CM)(7).However,certaincodeshavebeencombinedinthistabletoformlargercategoriesthatbetterdescribetheutilizationofambulatorycareservices.�2Basedon529,075,000visitsmadebyfemales.�3Basedon360,905,000visitsmadebymales.�NOTE:Numbersmaynotaddtototalsbecauseofrounding.

**Advance Data**  **No. 346**  + **August 26,**  **2004**

# Advance **Data No.**  **346** + **August 26,**  **2004** 27 **T**

**able 14.**  **Number ,**  **percent distribution,**  **and annual**  **rate of**  **injury-related o**  **ffice v**  **isits with**  **corresponding standard**  **e rrors,**  **b y**  **patient’s age,**  **sex, and**  **race: United**  **S tates,**  **2002** Number of Number of Standard Standard visits per Standard

visits in error i n Percent error o f 100 persons error o f Patient’s age, sex, and race thousands thousands distribution percent per year 1 rate A l l i n j u r y - r e l a t e d v i s i t s ......................... 104,028 5,656 100.0
. . . 36.7 2 .0 Age Under 15 years ............................. 1 7 , 0 2 1 1 , 1 8 7 1 6
. 4 1
. 1 2 8
. 1 2
. 0 15–24
................................... 1 1 , 3 2 7 1 , 2 0 3 1 0
. 9 0
. 9 2 8
. 7 3
. 0 25–44
................................... 2 7 , 1 1 1 2 , 0 6 8 2 6
. 1 1
. 1 3 2
. 7 2
. 5 45–64
................................... 2 9 , 3 0 4 2 , 0 6 3 2 8
. 2 1
. 2 4 4
. 3 3
. 1 65–74
................................... 9 , 1 8 6 8 6 5 8
. 8 0
. 7 5 0
. 9 4
. 8 75 years and over ........................... 1 0 , 0 8 0 1 , 0 0 9 9
. 7 0
. 9 6 3
. 3 6
. 3 Sex and age Female

.................................. 5 2 , 0 3 6 2 , 9 4 1 5 0
. 0 1
. 1 3 5
. 9 2
. 0

Under 15 years ........................... 7 , 3 0 6 6 4 0 7
. 0 0
. 6 2 4
. 7 2
. 2 15–24
................................. 5 , 1 5 4 6 2 2 5
. 0 0
. 5 2 6
. 3 3
. 2 25–44
................................. 1 3 , 4 0 8 1 , 1 5 9 1 2
. 9 0
. 9 3 1
. 9 2
. 8 45–64
................................. 1 4 , 8 9 8 1 , 2 4 4 1 4
. 3 0
. 8 4 3
. 7 3
. 6 65–74
................................. 5 , 0 7 3 6 0 5 4
. 9 0
. 5 5 1
. 6 6
. 1 75 years and over .......................... 6 , 1 9 6 7 1 1 6
. 0 0
. 6 6 3
. 3 7
. 3 M a l e ................................... 5 1 , 9 9 2 3 , 1 6 9 5 0
. 0 1
. 1 3 7
. 7 2
. 3

Under 15 years ........................... 9 , 7 1 4 7 9 8 9
. 3 0
. 7 3 1
. 3 2
. 6 15–24
................................. 6 , 1 7 3 7 8 3 5
. 9 0
. 6 3 1
. 1 3
. 9 25–44
................................. 1 3 , 7 0 3 1 , 3 6 4 1 3
. 2 0
. 9 3 3
. 6 3
. 3 45–64
................................. 1 4 , 4 0 6 1 , 1 8 9 1 3
. 8 0
. 9 4 4
. 9 3
. 7 65–74
................................. 4 , 1 1 2 5 2 4 4
. 0 0
. 4 5 0
. 2 6
. 4 75 years and over .......................... 3 , 8 8 4 5 1 2 3
. 7 0
. 5 6 3
. 3 8
. 3 Race 2 W h i t e ................................... 9 0 , 7 1 7 5 , 1 9 4 8 7
. 2 1
. 0 3 9
. 6 2
. 3 B l a c k

................................... 8 , 8 7 0 9 3 4 8
. 5 0
. 8 2 5
. 1 2
. 6 O t h e r ................................... 4 , 4 4 1 6 4 1 4
. 3 0
. 6 2 3
. 6 3
. 4

. . . Category not applicable. 1 V i sit r ates for age, sex, and race are based on the July 1 , 2002, set of estimates of the c ivilian noninstitutional population o f t he United S tates a s dev eloped by the Population D ivision, U.S. Census Bureau. These population estimates reflect Census 2000 data and are available from t he U.S. Census Bureau. See ‘ ‘ T echnical Notes’ ’ f or more d e tails. 2 Other race includes visits by Asians, Native Hawaiians or other Pacific Islanders, American Indians or Alaska Natives, and multiple races. All r ace c ategories i nclude visits by persons of Hispanic and not Hispanic o rigin. Persons of Hispanic o rigin may be of any race. Starting w ith data year 1999, race-specific estimates have been tabulated acco rding t o 1997 Standards for Federal Data o n Race and Ethnicity and are not strictly comparable w ith estimates for earlier years. However , t he percent of visit r ecords with multiple races indica ted i s small and lower than what is typically found for self-reported r ace. See ‘ ‘ T echnical Notes’ ’ f or more details. NOTE: Numbers may not add to totals because of rounding. 

### T

**able 15.**  **Number and**  **percent distribution**  **o f**  **i njury-related**  **o ffice**  **v isits**  **with corresponding**  **standard e**  **rrors, b**  **y i**  **ntent and**  **mechanism of**  **external cause:**  **United S**  **tates, 2002**  Number of Standard Standard visits in error i n Percent error o f Intent and mechanism 1 thousands thousands distribution percent A l l i n j u r y - r e l a t e d v i s i t s ................................ 104,028 5,656 100.0
. . . Unintentional injuries

................................ 5 8 , 7 2 0 4 , 1 8 1 5 6
. 4 1
. 8

F a l l s ......................................... 1 3 , 3 1 9 1 , 4 5 9 1 2
. 8 1
. 1 Struck against or struck accidentally by objects o r persons ....... 8 , 4 2 1 1 , 1 1 9 8
. 1 0
. 9 Overexertion and strenuous movements
................... 7 , 1 2 0 1 , 0 1 6 6
. 8 0
. 9 Motor vehicle traf fic

................................ 6 , 3 2 3 9 4 8 6
. 1 0
. 8 Natural and environmental factors

....................... 3 , 3 1 7 4 4 8 3
. 2 0
. 4 Cutting o r p iercing i nstruments o r objects

.................. 2 , 0 5 0 3 6 0 2
. 0 0
. 3 Other and not elsewhere c lassified 2

...................... 1 3 , 2 0 7 1 , 3 0 7 1 2
. 7 1
. 1 Mechanism unspecified

............................. 4 , 9 6 4 7 3 5 4
. 8 0
. 6 Intentional injuries 3

.................................. * 9 5 7 3 4 2 * 0
. 9 0
. 3 Injuries o f undetermined intent

.......................... *

. . . *

. . . Adverse ef fects o f medical treatment
....................... 4 , 7 8 4 5 3 7 4
. 6 0
. 5 Blank cause 4

..................................... 3 9 , 5 1 2 2 , 5 5 9 3 8
. 0 1
. 8

. . . Category not applicable. * F igure does not meet standard o f r eliability or precision. 1 Based on the International Classification o f D iseases, 9th Revision, Clinical Modification (ICD–9–CM), Supplementary C lassification o f External Causes of Injury and Poisoning (7). A detailed description o f t he ICD–9–CM E-codes used to create t he groupings in this table i s p rovided in the ‘ ‘T echnical Notes.’ ’ 2 Includes suf focation, poisoning, other transportation, machinery , firearm, fire and flames, drowning/submersion, nontraf fic motor vehicle, an d pedal cycle. 3 Includes assault, self-inflicted, and other causes of violence. 4 Includes illegible entries and blanks. NOTE: Numbers may not add to totals because of rounding.

# 28 **Advance Data**  **No. 346**  + **August 26,**  **2004 T** 

**able 16.**  **Number and**  **percent of**  **office v**  **isits with**  **corresponding standard**  **e rrors,**  **b y**  **d iagnostic**  **and screening**  **services ordered**  **or provided,**  **according to**  **patient’s sex:**  **United S**  **tates, 2002**  Patient’ s sex Female 2 Male 3 Number of Standard Standard Standard Standard Diagnostic and screening visits in error i n Percent error o f Percent error o f Percent error o f services ordered or provided thousands 1 thousands of visits percent of visits percent of visits percent A l l v i s i t s .............................. 889,980 28,1 1 0
. . . . . . . . . . . . . . . . . . None

................................ 126,218 8,955 14.2 1 .0 13.5 1 .0 15.3 1 .1 Examinations General medical examination

................. 442,299 20,837 49.7 1 .7 48.9 1 .8 50.8 1 .7 Other examination

........................ 206,336 13,261 23.2 1 .2 25.2 1 .2 20.3 1 .3 Diagnostic tests Blood pressure .......................... 428,01 1 21,1 1 4 48.1 1 .5 51.5 1 .7 43.1 1 .6 EKG 4

................................ 3 1 , 7 9 0 5 , 6 9 4 3
. 6 0
. 6 3
. 5 0
. 8 3
. 7 0
. 5 Any scope procedure

...................... 1 8 , 8 8 2 1 , 9 7 8 2
. 1 0
. 2 2
. 1 0
. 2 2
. 2 0
. 3

Sigmoidoscopy/colonoscopy

................ 9 , 7 7 2 1 , 5 2 7 1
. 1 0
. 2 1
. 0 0
. 2 1
. 2 0
. 2 Endoscopy

........................... 6 , 3 8 7 7 9 1 0
. 7 0
. 1 0
. 8 0
. 1 0
. 6 0
. 1 Cystoscopy

........................... 1 , 8 7 4 2 5 6 0
. 2 0
. 0 0
. 1 0
. 0 0
. 3 0
. 0 C a r d i a c s t r e s s t e s t
........................ 3 , 7 4 0 6 6 2 0
. 4 0
. 1 0
. 3 0
. 1 0
. 6 0
. 1 Audiometry

............................ 3 , 7 0 6 8 3 2 0
. 4 0
. 1 0
. 3 0
. 1 0
. 5 0
. 2 T uberculin skin t est
....................... 2 , 8 3 9 6 4 7 0
. 3 0
. 1 0
. 3 0
. 1 0
. 3 0
. 1 EEG 5

................................ 8 2 5 1 5 0 0
. 1 0
. 0 0
. 1 0
. 0 0
. 1 0
. 0 F e t a l m o n i t o r i n g ......................... * 1 , 5 2 6 5 0 2 * 0
. 2 0
. 1 * 0
. 3 0
. 1
. . . . . . Laboratory t ests CBC 6

................................ 7 8 , 1 1 8 6 , 3 1 9 8
. 8 0
. 7 8
. 8 0
. 7 8
. 8 0
. 7 U r i n a l y s i s ............................. 8 5 , 7 2 3 7 , 0 1 3 9
. 6 0
. 7 1 1
. 3 1
. 0 7
. 2 0
. 6 Cholesterol

............................ 4 6 , 2 6 0 4 , 6 8 4 5
. 2 0
. 5 4
. 7 0
. 5 6
. 0 0
. 7 PSA 7

................................ 1 4 , 8 7 0 1 , 5 8 5 1
. 7 0
. 2
. . . . . . 4
. 1 0
. 4 Hematocrit/hemoglobin

..................... 2 8 , 3 2 1 4 , 6 4 1 3
. 2 0
. 5 3
. 7 0
. 7 2
. 4 0
. 4 P a p t e s t
.............................. 3 6 , 3 4 1 2 , 9 8 1 4
. 1 0
. 3 6
. 9 0
. 5
. . . . . . Cultures A n y c u l t u r e ............................ 3 1 , 3 3 1 2 , 6 0 1 3
. 5 0
. 3 3
. 7 0
. 3 3
. 2 0
. 3

T h r o a t / r a p i d s t r e p t e s t
.................... 1 5 , 0 3 6 1 , 7 2 8 1
. 7 0
. 2 1
. 6 0
. 2 1
. 8 0
. 3 U r i n e .............................. 6 , 0 6 6 1 , 0 2 8 0
. 7 0
. 1 0
. 7 0
. 1 0
. 6 0
. 2 S t o o l

.............................. 1 , 8 8 6 4 5 6 0
. 2 0
. 1 *

. . . *

. . . C e r v i c a l / u r e t h r a l

........................ 3 , 9 3 3 5 8 2 0
. 4 0
. 1 0
. 7 0
. 1
. . . . . . Imaging Any imaging

............................ 9 6 , 7 8 1 5 , 9 6 9 1 0
. 9 0
. 6 1 2
. 0 0
. 7 9
. 2 0
. 7

X r a y ............................... 5 3 , 4 5 8 4 , 8 4 2 6
. 0 0
. 5 5
. 7 0
. 6 6
. 4 0
. 6 Ultrasound

........................... 8 , 5 7 8 1 , 0 4 7 1
. 0 0
. 1 1
. 2 0
. 2 0
. 7 0
. 1 Mammography

......................... 1 7 , 5 6 0 1 , 9 1 6 2
. 0 0
. 2 3
. 3 0
. 3
. . . . . . Other imaging

......................... 3 2 , 2 9 8 2 , 0 6 2 3
. 6 0
. 2 3
. 9 0
. 3 3
. 3 0
. 3 B l a n k

................................ * 8 , 3 3 1 3 , 0 1 6 * 0
. 9 0
. 3 * 0
. 9 0
. 4 * 1
. 0 0
. 3

. . . Category not applicable. * F igure does not meet standard o f r eliability or precision.� 0.0 Quantity more t han zero, but less than 0.05.� 1 T

o tal exceeds ‘ ‘ All v isits’ ’ because more t han one service may be reported per visit.� 2 Based on 529,075,000 visits made by females.� 3 Based on 360,905,000 visits made by males.� 4 EKG is electrocardiogram.� 5 EEG is electroencephalogram.� 6 CBC is complete b lood count.� 7 PSA is prostate-specific antigen.�

# Advance **Data No.**  **346** + **August 26,**  **2004** 29 **T**

**able 17.**  **Number and**  **percent of**  **office v**  **isits with**  **corresponding standard**  **e rrors,**  **b y**  **counseling, education,**  **or therapeutic**  **services ordered**  **or provided,**  **according to**  **patient’s sex:**  **United S**  **tates, 2002**  Patient’ s sex Female 2 Male 3 Number of Standard Standard Standard Standard Counseling, education, or therapeutic visits in error i n Percent error o f Percent error o f Percent error o f services ordered or provided thousands 1 thousands of visits percent of visits percent of visits percent A l l v i s i t s .............................. 889,980 28,1 1 0
. . . . . . . . . . . . . . . . . . None

................................ 473,435 17,926 53.2 1 .5 52.0 1 .6 55.0 1 .5 Counseling/education Diet/nutrition

............................ 127,699 7,954 14.3 0 .8 15.0 0 .9 13.4 0 .8 Exercise

.............................. 8 9 , 0 8 7 7 , 1 9 1 1 0
. 0 0
. 7 1 0
. 5 0
. 8 9
. 3 0
. 8 Mental health/stress management
.............. 4 0 , 7 6 4 4 , 0 6 2 4
. 6 0
. 4 4
. 9 0
. 5 4
. 2 0
. 5 W e ight reduction

......................... 3 2 , 0 5 0 3 , 3 9 7 3
. 6 0
. 4 3
. 9 0
. 5 3
. 1 0
. 3 Growth/development

....................... 2 9 , 1 0 0 3 , 0 3 7 3
. 3 0
. 3 3
. 0 0
. 3 3
. 6 0
. 4 T obacco use/exposure

..................... 2 3 , 6 7 4 2 , 0 3 3 2
. 7 0
. 2 2
. 5 0
. 2 2
. 9 0
. 3 Physiotherapy

........................... 2 2 , 5 3 1 4 , 7 1 0 2
. 5 0
. 5 2
. 4 0
. 5 2
. 8 0
. 5 Asthma education

........................ 1 8 , 3 3 9 2 , 8 1 1 2
. 1 0
. 3 2
. 0 0
. 4 2
. 1 0
. 3 Psychotherapy

.......................... 1 8 , 2 3 1 2 , 6 4 8 2
. 0 0
. 3 1
. 8 0
. 2 2
. 3 0
. 5 O t h e r ................................ 190,849 13,299 21.4 1 .2 22.4 1 .3 20.0 1 .2 B l a n k

................................ 1 8 , 4 9 8 3 , 5 6 7 2
. 1 0
. 4 2
. 3 0
. 5 1
. 8 0
. 3

. . . Category not applicable.� 1 Numbers may not add to totals because more t han one type of therapeutic or preventive service may be reported per visit.� 2 Based on 529,075,000 visits made by females.� 3 Based on 360,905,000 visits made by males.�


### T

**able 18.**  **Number and**  **percent distribution**  **o f**  **w rite-in**  **surgical procedures**  **ordered or**  **performed with**  **corresponding standard**  **e rrors,**  **b y**  **procedure category:**  **United S**  **tates, 2002**  Number of Standard Standard procedures error i n Percent error o f Procedure/operation category 1 ICD–9–CM codes in thousands thousands distribution percent All w rite-in surgical procedures

................... 6 9 , 7 9 6 4 , 1 1 4 100.0
. . . Nervous system
............................ 01–05 1,830 385 2.6 0 .5 E y e .................................... 08–16 6,782 1,083 9.7 1 .4 E a r .................................... 18–20 1,458 288 2.1 0 .4 Nose, mouth, and pharynx

...................... 21–29 2,777 459 4.0 0 .6 Cardiovascular system
........................ 35–39 3,393 800 4.9 1 .1 Digestive system
............................ 42–54 5,481 849 7.9 1 .2 Urinary system
............................. 55–59 1,171 216 1.7 0 .3 Male genital o rgans .......................... 60–64 1,830 324 2.6 0 .4 Female genital o rgans ......................... 65–71 3,927 613 5.6 0 .9 Obstetrical procedures

........................ 72–75 2,032 534 2.9 0 .7 Musculoskeletal system
........................ 76–84 8,820 1,084 12.6 1 .6 Integumentary system
......................... 85–86 29,469 2,705 42.2 2 .4 Other procedures 2

........................... 8 2 6 1 7 8 1
. 2 0
. 3

. . . Category not applicable. 1 Based on the International Classification o f D iseases, 9th Revision, Clinical Modification (ICD–9–CM) (7). 2 Includes operations on the endocrine system (ICD–9–CM codes 06–07), operations on the r espiratory system (ICD–9–CM codes 30–34), operations on the hemic and lymphatic system (ICD–9–CM codes 40–41). NOTES: Included are r esponses to the surgery item o n t he Patient Record f orm (item 8 ) ( up to two p rocedures could b e r eported), and the d iagnostic/scre ening services item (item 6 ) (up to two procedures can be reported i n t he ‘ ‘ scope procedure-specify’ ’ and the ‘ ‘other service-specify’ ’ categories). M iscellaneous diagnostic and thera peutic procedures (nonsurgical procedures) were not included in the t otal. These procedures, coded to ICD–9–CM volumn 3, range 87–99, represented 1 13,864,000 procedures.

# 30 **Advance Data**  **No. 346**  + **August 26,**  **2004 T** 

**able 19.**  **Number and**  **percent distribution**  **o f**  **o ffice**  **v isits**  **with corresponding**  **standard errors,**  **b y**  **medication t**  **herapy and**  **number of**  **medications provided**  **or prescribed,**  **according to**  **patient’s sex:**  **United States,**  **2002** Patient’ s sex Female 1 Male 2 Number of Standard Standard Standard Standard

visits in error i n Percent error o f Percent error o f Percent error o f V i sit characteristic thousands thousands distribution percent distribution percent distribution percent Medication t herapy 3 A l l v i s i t s .............................. 889,980 28,1 1 0 100.0
. . . 100.0
. . . 100.0
. . . Drug visits 4

............................ 577,075 20,898 64.8 1 .1 65.5 1 .2 63.9 1 .3 V i sits without mention o f medication

............. 312,906 13,755 35.2 1 .1 34.5 1 .2 36.1 1 .3 Number of medications provided or prescribed by a physician A l l v i s i t s .............................. 889,980 28,1 1 0 100.0
. . . 100.0
. . . 100.0
. . . 0
................................... 312,906 13,755 35.2 1 .1 34.5 1 .2 36.1 1 .3 1
................................... 239,750 9,396 26.9 0 .6 26.9 0 .7 27.0 0 .7 2
................................... 146,236 6,619 16.4 0 .5 16.6 0 .6 16.2 0 .6 3
................................... 7 6 , 3 1 7 4 , 3 8 2 8
. 6 0
. 4 8
. 8 0
. 5 8
. 3 0
. 4 4
................................... 3 9 , 5 9 4 2 , 6 9 9 4
. 4 0
. 3 4
. 4 0
. 3 4
. 5 0
. 3 5
................................... 2 3 , 3 0 9 1 , 8 3 9 2
. 6 0
. 2 2
. 8 0
. 3 2
. 3 0
. 2 6
................................... 5 1 , 8 7 1 4 , 7 2 7 5
. 8 0
. 5 6
. 0 0
. 5 5
. 5 0
. 5

. . . Category not applicable.� 1 Based on 529,075,000 visits made by females.� 2 Based on 360,905,000 visits made by males.� 3 Includes prescription d rugs, over-the-counter preparations, immunizations, and desensitizing agents.� 4 V i sits at which one or more d rugs were p rovided or prescribed by the physician.� NOTE: Numbers may not add to totals because of rounding.**T able** **20. Number** **and percent** **distribution o** **f d** **rug v** **isits, and** **percent drug** **visits, d** **rug mentions,** **and drug** **mention rates** **per 100** **visits with** **correspon ding** **standard e** **rrors, b** **y physician** **specialty: United** **S tates,** **2002**DrugvisitsDrugmentionsPercentdrugvisitsDrugmentionratesNumberofdrugStandardStandardStandardStandardPercentStandardmentionsStandardNumberinerrorinPercenterrorofNumberinerrorinPercenterrorofdrugerrorofper100errorofPhysicianspecialtythousands1thousandsdistributionpercentthousands2thousandsdistributionpercentvisits3percentvisits4rateAllspecialties..................577,07520,898100.0...1,347,31258,464100.0...64.81.1151.44.7Generalandfamilypractice.........165,37110,39428.71.5402,06729,01029.81.876.81.3186.68.1Internalmedicine................115,21912,44220.01.8310,00638,97923.02.373.53.5197.815.3Pediatrics....................80,8146,03314.01.0149,57212,20811.10.967.31.5124.64.8Obstetricsandgynecology..........34,3554,0246.00.757,9378,6084.30.648.93.582.49.1Ophthalmology.................25,0663,2274.30.554,1509,1424.00.750.23.0108.413.0Dermatology...................21,2922,5813.70.439,1804,9892.90.466.12.6121.66.8Psychiatry....................17,9012,7593.10.539,7356,0982.90.582.62.7183.59.3Cardiovasculardiseases...........15,8892,3372.80.464,08810,8514.80.876.34.8307.830.4Orthopedicsurgery...............14,2932,3192.50.423,2143,9011.70.337.63.961.07.7Urology......................8,3521,0781.40.211,7601,5910.90.148.83.068.65.2Otolaryngology.................8,0331,1331.40.214,3292,5181.10.247.03.383.910.0Neurology....................5,7995871.00.112,3681,5860.90.160.33.9128.512.1Generalsurgery................4,7731,2050.80.2*10,3143,313*0.80.228.14.960.715.4Allotherspecialties..............59,9196,79210.41.1158,59319,29311.81.457.64.5152.515.2...Categorynotapplicable.1Visitsatwhichoneormoredrugswereprovidedorprescribedbythephysician.2Numberofdrugsmentionedatvisits(uptosixpervisit).3Percentofvisitsthatincludedoneormoredrugmentions(numberofdrugvisitsdividedbynumberofofficevisitsmultipliedby100).4Averagenumberofdrugsthatwerementionedper100visits(numberofdrugmentionsdividedbytotalnumberofvisitsmultipliedby100).NOTE:Numbersmaynotaddtototalsbecauseofrounding.

**Advance Data**  **No. 346**  + **August 26,**  **2004** 31�

# 32 **Advance Data**  **No. 346**  + **August 26,**  **2004 T** 

**able 21.**  **Number and**  **percent of**  **drug mentions**  **for t**  **he 20**  **most frequently**  **occurring t**  **herapeutic classes**  **at office**  **v isits**  **with corresponding**  **standard e**  **rrors: United**  **S tates,**  **2002** Number of Standard Percent Standard occurrences error i n of drug error Therapeutic classfication 1 in thousands thousands mentions 2 of percent NSAIDs 3

........................................ 6 6 , 3 2 8 4 , 7 1 8 4
. 9 0
. 2 Antidepressants

................................... 6 0 , 3 6 7 3 , 7 1 4 4
. 5 0
. 2 A n t i h i s t a m i n e s .................................... 5 8 , 0 6 0 4 , 4 7 3 4
. 3 0
. 3 Antiasthmatics/bronchodilators

.......................... 5 4 , 5 6 2 5 , 8 9 3 4
. 0 0
. 4 V

accines/antisera

................................... 5 3 , 7 8 5 4 , 9 4 2 4
. 0 0
. 4 Antihypertensive agents
.............................. 4 9 , 2 9 8 4 , 3 6 4 3
. 7 0
. 3 Hyperlipidemia

.................................... 4 4 , 0 6 5 3 , 2 9 0 3
. 3 0
. 2 Blood glucose regulators

.............................. 4 1 , 8 6 5 4 , 3 0 2 3
. 1 0
. 3 ACE 4 i n h i b i t o r s .................................... 4 0 , 9 2 7 3 , 0 2 6 3
. 0 0
. 2 D i s o r d e r s , a c i d / p e p t i c ................................ 4 0 , 8 1 2 2 , 6 9 5 3
. 0 0
. 1 Analgesics, non-narcotic

.............................. 3 9 , 7 5 3 3 , 2 4 7 3
. 0 0
. 2 Penicillins

....................................... 3 8 , 0 7 5 2 , 5 4 0 2
. 8 0
. 2 D i u r e t i c s ........................................ 3 5 , 9 4 2 3 , 1 2 1 2
. 7 0
. 2 A n t i p y r e t i c s ...................................... 3 4 , 7 8 4 3 , 0 4 7 2
. 6 0
. 2 Analgesics, narcotic

................................. 3 4 , 7 3 9 2 , 9 3 1 2
. 6 0
. 2 Beta b lockers

..................................... 3 3 , 0 9 0 2 , 7 2 7 2
. 5 0
. 2 Calcium channel blockers

............................. 3 1 , 9 9 8 2 , 7 6 8 2
. 4 0
. 2 V i t a m i n s / m i n e r a l s .................................. 3 0 , 1 5 4 3 , 2 9 7 2
. 2 0
. 2 Antiarthritics

...................................... 2 8 , 9 5 5 2 , 4 0 8 2
. 1 0
. 1 Estrogens/progestins

................................ 2 8 , 3 5 9 2 , 4 3 3 2
. 1 0
. 2
1 Based on the s tandard f our-digit drug classification used in the National Drug Code (NDC) Directory , 1995 edition ( 10).� 2 Based on an estimated 1,347,312,000 drug mentions at of fice v isits in 2002.� 3 NSAIDs are nonsteroidal anti-inflammatory d rugs.� 4 ACE is angiotensin-converting enzyme.�


### T

**able 22.**  **Number and**  **rate of**  **generic substances**  **for t**  **he 20**  **most frequently**  **occurring generic**  **substances in**  **drug mentions**  **at office**  **visits with**  **corresponding standard**  **e rrors:**  **United S**  **tates, 2002**  Number of generic Number of Standard substances Standard occurrences error i n per 100 error o f Generic substance in thousands 1 thousands drug mentions 2 rate Acetaminophen

............................. 4 5 , 3 8 1 3 , 6 9 4 3
. 4 0
. 2 Amoxicillin

................................ 3 5 , 7 9 1 2 , 4 4 4 2
. 7 0
. 2 Hydrochlorothiazide

.......................... 2 8 , 4 0 6 2 , 8 1 2 2
. 1 0
. 2 A l b u t e r o l

................................. 2 5 , 1 7 4 2 , 6 9 4 1
. 9 0
. 2 Aspirin

.................................. 2 3 , 4 0 9 2 , 1 4 5 1
. 7 0
. 1 Hydrocodone

.............................. 2 1 , 6 4 3 2 , 2 0 6 1
. 6 0
. 1 Fluticasone propionate

........................ 2 0 , 6 2 6 2 , 3 9 4 1
. 5 0
. 2 Levothyroxine

.............................. 1 9 , 2 4 8 1 , 9 9 2 1
. 4 0
. 1 Atorvastatin calcium

.......................... 1 9 , 0 6 2 1 , 5 8 5 1
. 4 0
. 1 Ibuprofen

................................. 1 7 , 6 5 1 1 , 3 9 7 1
. 3 0
. 1 L i s i n o p r i l

................................. 1 7 , 3 2 0 1 , 5 9 0 1
. 3 0
. 1 Pseudoephedrine

............................ 1 6 , 7 7 0 1 , 9 2 8 1
. 2 0
. 1 Furosemide

............................... 1 6 , 5 0 7 1 , 5 9 9 1
. 2 0
. 1 Guaifenesin

............................... 1 5 , 8 2 2 1 , 7 9 3 1
. 2 0
. 1 M e t o p r o l o l

................................ 1 5 , 7 6 7 1 , 4 8 5 1
. 2 0
. 1 A m l o d i p i n e ................................ 1 5 , 6 4 3 1 , 4 5 1 1
. 2 0
. 1 Azithromycin

.............................. 1 4 , 1 2 5 1 , 3 5 1 1
. 0 0
. 1 Estrogens

................................ 1 3 , 9 7 3 1 , 4 7 4 1
. 0 0
. 1 Celecoxib

................................ 1 3 , 7 6 3 1 , 6 4 1 1
. 0 0
. 1 T riamcinolone

.............................. 1 3 , 0 3 9 1 , 6 1 0 1
. 0 0
. 1
1 Frequency of mention combines single-ingredient agents w ith mentions of the agent as an ingredient in a combination d rug. 2 Based on an estimated 1,347,312,000 drug mentions at of fice v isits in 2002.

# Advance **Data No.**  **346** + **August 26,**  **2004** 33 **T**

**able 23.**  **Number ,**  **percent distribution,**  **and therapeutic**  **classification f**  **or the**  **2 0**  **d rugs**  **most frequently**  **prescribed at**  **office v**  **isits with**  **corresponding standard**  **e rrors,**  **b y**  **entry name**  **of drug:**  **United S**  **tates, 2002**  Number of Standard Standard drug mentions error i n Percent error o f Entry name of drug 1 in thousands thousands distribution percent Therapeutic classification 2 A l l d r u g m e n t i o n s ........... 1 , 347,312 58,464 100.0
. . . . . . L i p i t o r .................. 1 8 , 8 4 2 1 , 5 7 7 1
. 4 0
. 1 Hyperlipidemia A l b u t e r o l

................ 1 5 , 4 4 2 1 , 8 6 0 1
. 1 0
. 1 A n t i a s t hmatics/bronchodilators Amoxicillin

............... 1 4 , 6 9 0 1 , 4 2 3 1
. 1 0
. 1 Penicillins Synthroid

................ 1 4 , 5 2 5 1 , 7 0 8 1
. 1 0
. 1 Thyroid/antithyroid Lasix

.................. 1 4 , 0 0 4 1 , 4 5 4 1
. 0 0
. 1 D i u r e t i c s C e l e b r e x ................ 1 3 , 7 6 3 1 , 6 4 1 1
. 0 0
. 1 NSAIDs 3 T y lenol

................. 1 2 , 9 1 9 2 , 3 6 8 1
. 0 0
. 2 Nonnarcotic analgesics; antipyretics V i o x x .................. 1 2 , 6 5 0 1 , 7 2 4 0
. 9 0
. 1 NSAIDs 3 Augmentin

............... 1 1 , 9 9 5 1 , 1 5 6 0
. 9 0
. 1 Penicillins Norvasc

................ 1 1 , 8 5 3 1 , 1 7 2 0
. 9 0
. 1 C a l c i u m channel blockers Z y r t e c .................. 1 1 , 5 7 3 1 , 3 7 7 0
. 9 0
. 1 A n t i h i s t a m i n e s Zocor

.................. 1 1 , 4 2 9 1 , 1 7 1 0
. 8 0
. 1 Hyperlipidemia A.S.A. 4

................. 1 0 , 6 7 0 1 , 3 4 5 0
. 8 0
. 1 Nonnarcotic analgesics; antiarthritics; antipyretics Prednisone

.............. 1 0 , 4 2 2 1 , 1 7 1 0
. 8 0
. 1 A d r enal corticosteroids A l l e g r a ................. 1 0 , 4 2 0 1 , 3 1 5 0
. 8 0
. 1 A n t i h i s t a m i n e s Coumadin

............... 1 0 , 0 9 0 1 , 2 7 3 0
. 7 0
. 1 A n t i coagulants/thrombolytics Atenolol

................ 9 , 6 9 4 1 , 1 8 6 0
. 7 0
. 1 B e t a b l ockers Claritin

................. 9 , 2 0 8 1 , 1 7 9 0
. 7 0
. 1 A n t i h i s t a m i n e s Paxil

.................. 9 , 1 1 8 9 2 4 0
. 7 0
. 1 A n t i depressants Prevacid

................ 8 , 9 8 1 9 0 1 0
. 7 0
. 1 A c i d / peptic disorders A l l o t h e r ................ 1 , 105,025 46,612 82.0 0 .5
. . .

. . . Category not applicable. 1 The entry made by the physician on the p rescription o r o ther medical records. This may be a trade name, generic name, or desired t herapeutic ef fect. 2 Therapeutic classification i s based on the National Drug Code Directory , 1995 edition ( 10). I n cases where a d rug had more t han one therapeutic use, it was classified under each therapeutic class. 3 NSAIDs are nonsteroidal anti-inflammatory d rugs. 4 A.S.A. is acetylsalicylic acid. NOTE: Numbers may not add to totals because of rounding.



### T

**able 24.**  **Number and**  **percent of**  **office v**  **isits with**  **corresponding standard**  **e rrors,**  **b y**  **p roviders**  **seen: United**  **S tates,**  **2002** Number of Standard Standard

visits in error i n Percent error o f T ype of provider thousands 1 thousands of visits percent A l l v i s i t s ................................. 889,980 28,1 1 0
. . . . . . Physician

................................. 846,167 27,573 95.1 0 .6 Medical/nursing assistant

....................... 243,082 19,551 27.3 1 .9 R.N. 2

................................... 146,513 15,495 16.5 1 .6 L.P

. N. 3

.................................. 8 8 , 9 0 2 1 3 , 2 0 2 1 0
. 0 1
. 4 Medical technician/technologist

................... 5 4 , 9 8 3 6 , 9 6 9 6
. 2 0
. 7 Physician assistant

........................... 1 6 , 2 6 4 3 , 5 2 5 1
. 8 0
. 4 Nurse practitioner/midwife

...................... * 1 1 , 1 7 6 3 , 6 5 6 * 1
. 3 0
. 4 O t h e r ................................... 3 1 , 7 8 4 8 , 0 3 8 3
. 6 0
. 9

. . . Category not applicable. * F igure does not meet standard o f r eliability or precision.� 1 T

o tal exceeds ‘ ‘ All v isits’ ’ because more t han one provider may be reported per visit.� 2 R.N. is registered nurse.� 3 L.P

. N. is licensed practical nurse.�

# 34 **Advance Data**  **No. 346**  + **August 26,**  **2004 T** 

**able 25.**  **Number and**  **percent of**  **office v**  **isits with**  **corresponding standard**  **e rrors,**  **b y**  **v isit**  **disposition: United**  **S tates,**  **2002** Number of Standard Standard

visits in error i n Percent error o f Disposition thousands 1 thousands of visits percent A l l v i s i t s ................................... 889,980 28,1 1 0
. . . . . . Return a t specified time

.......................... 537,891 20,764 60.4 1 .2 Return i f needed, P

. R.N 2

......................... 243,944 14,152 27.4 1 .1 No followup planned

............................ 7 5 , 2 0 6 4 , 9 2 3 8
. 5 0
. 5 Referred t o o ther physician

....................... 6 5 , 3 2 3 5 , 6 8 9 7
. 3 0
. 6 T e lephone followup planned

....................... 2 4 , 3 8 7 4 , 7 1 1 2
. 7 0
. 5 Admitted t o hospital

............................ 4 , 0 1 1 5 8 7 0
. 5 0
. 1 Other disposition

.............................. 1 8 , 4 5 4 4 , 3 4 8 2
. 1 0
. 5 B l a n k

..................................... 2 0 , 2 7 5 3 , 6 2 9 2
. 3 0
. 4

. . . Category not applicable.� 1 T

o tal exceeds ‘ ‘ All v isits’ ’ because more t han one disposition may be reported per visit.� 2 P

. R.N. is ‘ ‘ as needed.’ ’�


### T

**able 26.**  **Number and**  **percent distribution**  **o f**  **o ffice**  **v isits**  **with corresponding**  **standard errors,**  **b y**  **time spent**  **with physician:**  **United S**  **tates, 2002**  Number of Standard Standard visits in error i n Percent error o f T i me spent with physician thousands thousands distribution percent A l l v i s i t s ................................. 889,980 28,1 1 0 100.0
. . . V i sits at which no physician was seen ............... 4 3 , 8 1 3 5 , 1 4 0 4
. 9 0
. 6 V i sits at which a physician was seen ................ 846,167 27,573 95.1 0 .6 T o t a l

.................................... 846,167 27,573 100.0
. . . 1
– 5 m i n u t e s ............................. 3 8 , 3 9 3 5 , 4 1 2 4
. 5 0
. 6 6–10 minutes

............................. 181,078 1 1 ,403 21.4 1 .1 1 1–15 minutes

............................ 290,573 12,660 34.3 1 .0 16–30 minutes

............................ 275,653 13,529 32.6 1 .3 31–60 minutes

............................ 5 7 , 6 9 3 5 , 9 9 6 6
. 8 0
. 6 61 minutes and over ........................ 2 , 7 7 7 6 3 7 0
. 3 0
. 1

. . . Category not applicable.� NOTE: Numbers may not add to totals because of rounding.�


### T

**able 27.**  **Mean time**  **spent with**  **physician with**  **corresponding standard**  **e rrors,**  **b y**  **physician specialty:**  **United S**  **tates, 2002**  Mean time in minutes Standard spent with error o f 25th 75th Physician specialty physician 1 mean percentile Median percentile A l l v i s i t s ................................. 1 8
. 4 0
. 3 9
. 9 1 4
. 7 1 9
. 8 Psychiatry

................................ 3 5
. 2 1
. 7 1 9
. 8 2 9
. 6 4 8
. 2 Neurology

................................ 2 7
. 9 1
. 1 1 4
. 7 2 4
. 1 3 8
. 0 Cardiovascular diseases

....................... 2 1
. 4 1
. 2 1 3
. 6 1 8
. 0 2 8
. 2 Internal medicine

............................ 2 0
. 0 1
. 2 1 3
. 4 1 7
. 1 2 4
. 2 General surgery ............................ 1 9
. 6 1
. 0 9
. 9 1 4
. 5 2 4
. 4 U r o l o g y .................................. 1 8
. 2 0
. 8 1 4
. 1 1 4
. 8 1 9
. 6 Obstetrics and gynecology

...................... 1 8
. 1 0
. 9 9
. 8 1 4
. 7 1 9
. 8 Ophthalmology

............................. 1 7
. 3 1
. 1 9
. 5 1 4
. 4 1 9
. 6 Orthopedic surgery ........................... 1 7
. 1 0
. 5 1 3
. 2 1 4
. 3 1 8
. 8 General and family practice

..................... 1 6
. 1 0
. 3 9
. 8 1 4
. 5 1 9
. 3 Pediatrics

................................ 1 6
. 1 0
. 5 9
. 7 1 4
. 5 1 9
. 3 D e r m a t o l o g y ............................... 1 5
. 2 1
. 0 9
. 2 1 4
. 1 1 4
. 9 Otolaryngology

............................. 1 5
. 1 0
. 7 9
. 5 1 4
. 3 1 9
. 1 All o ther specialties

.......................... 2 1
. 3 1
. 0 1 4
. 1 1 5
. 0 2 5
. 7
1 Only v isits where a physician was seen are i ncluded.

# Advance **Data No.**  **346** + **August 26,**  **2004** 35 **T**

**able 28.**  **Office-based physician-level**  **estimates with**  **corresponding standard**  **e rrors,**  **b y**  **selected practice**  **characteristics according**  **to specialty**  **type: United**  **S tates,**  **2002** Specialty type Specialty type All Primary All Primary Practice characteristics specialties care Surgical Medical specialties care Surgical Medical Number of physicians Standard e rror All o f fice-based physicians

................... 308,023 154,725 78,430 74,868 8,149 4,674 3,438 3,793 Percent distribution T o tal sample

............................ 100.0 100.0 100.0 100.0
. . . . . . . . . . . . Number of in-scope of fice l ocations O n e ................................. 8 6
. 1 8 8
. 1 8 2
. 6 8 5
. 6 1
. 3 1
. 9 2
. 1 2
. 4 M o r e t h a n o n e .......................... 1 3
. 9 1 1
. 9 1 7
. 4 1 4
. 4 1
. 3 1
. 9 2
. 1 2
. 4 Number of days practicing during r andom NAMCS week 0
................................... 1 7
. 7 1 5
. 2 1 9
. 5 2 0
. 9 1
. 3 1
. 7 2
. 0 2
. 5 1
– 2
................................. 1 7
. 7 1 0
. 9 2 7
. 7 2 1
. 4 1
. 2 1
. 3 2
. 2 3
. 0 3
– 4
................................. 3 9
. 0 4 0
. 6 3 8
. 4 3 6
. 1 1
. 8 2
. 4 2
. 5 3
. 2 5 o r m o r e ............................. 2 5
. 7 3 3
. 3 1 4
. 4 2 1
. 7 1
. 4 2
. 3 1
. 8 2
. 5 T ype of practice S o l o ................................. 3 4
. 3 3 3
. 7 3 2
. 3 3 7
. 8 1
. 7 2
. 5 2
. 8 3
. 5 Single-specialty group ...................... 4 1
. 0 3 8
. 4 4 7
. 5 3 9
. 7 1
. 9 2
. 6 2
. 9 3
. 8 Multispecialty group ....................... 2 4
. 7 2 8
. 0 2 0
. 2 2 2
. 5 1
. 8 2
. 4 2
. 6 3
. 4 Employment status Owner

............................... 7 2
. 7 6 6
. 6 8 1
. 2 7 6
. 8 1
. 8 2
. 6 2
. 2 2
. 8 Employee

............................. 2 2
. 4 2 8
. 2 1 6
. 2 1 7
. 0 1
. 7 2
. 5 2
. 0 2
. 7 C o n t r a c t o r ............................. 4
. 8 5
. 2 2
. 7 6
. 2 0
. 7 1
. 1 0
. 9 1
. 6 Percent of physicians 1
T ype of consultation 2 Hospital v isits

........................... 6 9
. 8 7 0
. 0 7 9
. 5 5 8
. 9 1
. 7 2
. 5 2
. 7 3
. 5 T e lephone consultation

..................... 6 7
. 6 7 3
. 2 5 9
. 0 6 4
. 0 1
. 9 2
. 5 3
. 5 3
. 6 Home visits

............................ 1 2
. 5 1 9
. 1 5
. 6 5
. 3 1
. 3 2
. 4 1
. 3 1
. 5 E-mail/Internet consultation

.................. 5
. 9 6
. 8 5
. 0 4
. 8 1
. 0 1
. 5 1
. 5 1
. 3 Mean number in week 3 O f f i c e v i s i t s ............................ 7 6
. 5 9 2
. 4 6 3
. 5 5 7
. 3 1
. 9 3
. 2 2
. 3 3
. 5 T e lephone consultation

..................... 2 0
. 8 2 6
. 3 1 1
. 5 1 5
. 7 1
. 3 2
. 1 1
. 0 2
. 0 Hospital v isits

........................... 2 0
. 5 1 7
. 0 1 7
. 6 3 4
. 1 1
. 6 2
. 1 1
. 5 4
. 8 Home visits

............................ 1 0
. 1 1 1
. 7 2
. 6 6
. 0 1
. 8 2
. 2 0
. 7 1
. 8 E-mail/Internet consultations

.................. 6
. 0 5
. 7 7
. 3 5
. 2 1
. 2 1
. 8 2
. 4 1
. 1 Mean percent Percent of revenue from selected sources 4 Private i nsurance ......................... 4 8
. 3 5 2
. 7 4 3
. 7 4 4
. 1 1
. 0 1
. 3 1
. 4 2
. 0 Medicare

.............................. 2 9
. 8 2 4
. 6 2 8
. 2 3 1
. 8 0
. 9 1
. 1 1
. 3 1
. 8 Medicaid

.............................. 1 2
. 0 1 4
. 3 9
. 9 9
. 5 0
. 5 0
. 8 0
. 7 1
. 1 Other sources ........................... 1 0
. 3 8
. 2 9
. 4 1 5
. 9 0
. 8 0
. 8 1
. 2 2
. 1 Percent distribution Number of managed care contracts None

................................ 9
. 7 6
. 4 9
. 2 1 7
. 0 1
. 1 1
. 5 1
. 7 2
. 5 1
– 2
................................. 8
. 5 7
. 7 1 0
. 3 8
. 3 0
. 9 1
. 3 1
. 8 1
. 6 3–10
................................ 4 0
. 3 4 3
. 7 3 8
. 7 3 4
. 8 2
. 0 2
. 8 2
. 9 3
. 6 M o r e t h a n 1 0
........................... 3 5
. 4 3 6
. 5 3 6
. 8 3 1
. 5 2
. 0 2
. 6 2
. 9 3
. 7 B l a n k

................................ 6
. 2 5
. 6 5
. 1 8
. 5 1
. 1 1
. 3 1
. 4 2
. 3 See footnotes at end of table.

# 36 **Advance Data**  **No. 346**  + **August 26,**  **2004 T** 

**able 28.**  **Office-based physician-level**  **estimates with**  **corresponding standard**  **e rrors,**  **b y**  **selected practice**  **characteristics according**  **to specialty**  **type: United**  **S tates,**  **2002—Con.** Specialty type Specialty type All Primary All Primary Practice characteristics specialties care Surgical Medical specialties care Surgical Medical Percent of physicians Standard e rror Percent accepting new patients b y pay source 5 A n y p a t i e n t s ............................ 9 5
. 4 9 4
. 0 9 9
. 0 9 4
. 4 0
. 7 1
. 1 0
. 7 1
. 2 S e l f
- p a y .............................. 9 0
. 8 8 9
. 4 9 6
. 2 8 7
. 9 1
. 1 1
. 6 1
. 2 2
. 1 Medicare

.............................. 8 0
. 2 7 1
. 8 9 6
. 4 8 0
. 8 1
. 2 2
. 0 1
. 1 2
. 3 Noncapitated p rivate i nsurance ................ 7 8
. 1 8 0
. 2 8 3
. 1 6 8
. 2 1
. 6 2
. 2 2
. 4 3
. 3 Medicaid

.............................. 7 0
. 5 6 7
. 4 8 0
. 0 6 6
. 8 1
. 7 2
. 6 2
. 5 2
. 9 W o rker’s compensation

..................... 5 9
. 2 5 1
. 9 7 7
. 8 5 4
. 7 1
. 8 2
. 6 2
. 6 3
. 2 Capitated p rivate i nsurance .................. 5 3
. 4 5 7
. 8 4 9
. 6 4 8
. 1 2
. 1 2
. 8 3
. 4 3
. 5 No charge/charity

........................ 5 3
. 2 5 0
. 5 6 1
. 0 5 0
. 4 2
. 0 2
. 7 3
. 1 3
. 5 Percent of physicians Electronic patient records 6 Medical

............................... 1 7
. 3 1 8
. 0 1 8
. 8 1 4
. 3 1
. 1 2
. 1 2
. 9 2
. 7 Billing

................................ 7 4
. 4 7 7
. 1 7 7
. 5 6 5
. 4 1
. 6 2
. 3 2
. 5 3
. 5

. . . Category not applicable. 1 Percent of physicians reporting any consultations during a t ypical week of work. Missing values ranged from 1 2 t o 1 6 percent depending on type of consu ltation. 2 Missing values ranged from 1 2 t o 1 6 percent depending on type of consulation. 3 Mean number of consultations during a t ypical week of work f or physicians with any of that type of consultation. 4 Missing values ranged from 1 0 t o 2 0 percent depending on revenue source. 5 Missing values ranged from 3 to 15 percent depending on payment method. The missing value for accepting any new patients i s 0 .6 percent. 6 Missing values are about 1.7 percent for e lectronic medical records and 5.1 percent for e lectronic b illing r ecords. NOTES: Estimates of of fice-based physicians exclude the specialties o f anesthesiology , r adiology , and pathology

. Numbers may not add to totals bec ause of rounding.

# Advance **Data No.**  **346** + **August 26,**  **2004** 37 **T**

**able I**  **. Coefficients**  **appropriate for**  **determining approximate**  **r elative**  **s tandard**  **e rrors**  **by** 

# T

**echnical Notes**  **type of**  **estimate and**  **physician specialty:**  **National Ambulatory**  **Medical Care**  **Survey ,**  **2002** 

# Data **collection** The NAMCS data collection is authorized under Section 308d of the Public Health Service Act (T itle 42 United States Code, Section 306[242k]). Participation is voluntary
. I n 2002, of the 1,492 in-scope physicians who participated in the NAMCS, 1,233 of them completed 28,738 Patient Record forms, and 259 physicians reported no patients during their sampled week. Also, for physicians who completed Patient Record forms, 98.5 percent (N=1,215) responded fully or adequately , and 1.5 percent (N=18) responded minimally , for an unweighted physician participation rate of 71.2 percent. The U.S. Census Bureau, acting as the data collection agent for the survey , provided training to field representatives (FRs) throughout the Nation. They , i n turn, oversaw data collection at the physician’s of fice. FRs contacted physicians for induction into the survey after an advance letter was mailed by NCHS notifying the physicians of their selection for the survey . I n most cases, physicians’ and/or their staf f completed the information requested on the Patient Record forms (see figure I )
. However , i n 30.3 percent of the of fices, FRs abstracted the data from medical records or computer printouts, either alone or with the doctor or of fice staf f. No personally identifying information such as patient name or address is collected. Confidentiality of the data collected in the survey is protected under the Privacy Act, Public Health Service Act, T

itle 42 of the United States Code, Section 242m (d), and T itle V o f the E-Government Act of 2002. **Sampling errors**  The standard error is primarily a measure of the sampling variability that occurs by chance when only a sample, rather than an entire universe, is surveyed. The standard error does not measure any systematic biases in the data. The standard errors presented in the tables and used in tests of significance Coef ficient for use with estimates in thousands Lowest reliable estimate (in T ype of estimate and physician specialty A B thousands) V i sits Overall t otals

......................... 0
. 001885 67.975 771 General and family practice

................ 0
. 005017 46.488 548 Internal medicine

...................... 0
. 0121 14 1 17.073 1,504 Pediatrics

........................... 0
. 005394 51.389 608 General surgery ....................... 0
. 016740 20.945 286 Obstetrics and gynecology

................ 0
. 0 1 1 1 8 2 7 4
. 8 4 0 9 5 0 Orthopedic surgery ...................... 0
. 018688 45.179 634 Cardiovascular diseases

.................. 0
. 015939 23.877 323 D e r m a t o l o g y .......................... 0
. 014560 27.893 370 U r o l o g y ............................. 0
. 012960 19.354 252 Psychiatry

........................... 0
. 016826 36.280 496 Neurology

........................... 0
. 009287 8.185 102 Ophthalmology

........................ 0
. 012374 71.024 915 Otolaryngology

........................ 0
. 015390 13.691 184 All o ther specialties

..................... 0
. 0 1 1088 79.546 1,009 Drug mentions Overall t otals

......................... 0
. 003469 132.030 1,526 General and family practice

................ 0
. 006536 126.282 1,513 Internal medicine

....................... 0
. 018887 330.478 4,647 Pediatrics

........................... 0
. 007724 107.747 1,310 General surgery ....................... 0
. 042731 52.401 1,109 Obstetrics and gynecology

................. 0
. 0251 14 126.290 1,946 Orthopedic surgery ...................... 0
. 026888 71.607 1,135 Cardiovascular diseases

.................. 0
. 031081 79.640 1,352 D e r m a t o l o g y .......................... 0
. 014363 63.287 837 U r o l o g y ............................ 0
. 019728 25.141 358 Psychiatry

........................... 0
. 022866 90.933 1,355 Neurology

........................... 0
. 015312 21.435 287 Ophthalmology

........................ 0
. 027404 124.499 1,989 Otolaryngology

........................ 0
. 032009 21.442 370 All o ther specialties

..................... 0
. 016159 271.348 3,675 NOTE: These coef ficients apply t o NAMCS data where doctors o f osteopathy (D.O.s) have been aggregated with doctors of medicine (M.D.s) according to their self-designated practice specialty

. For those who wish to conduct a separate analysis o n visits to doctors o f osteopathy , t he A and B coef ficients f or use with visit estimates in thousands are 0 .01 1915 and 29.949, respectively

. The corresponding coef ficients f or estimates of drug mentions in thousands are 0 .012174 and 99.018. T o perform analyses of NAMCS data o n v isits to M.D.’s only , excluding doctors o f osteopathy , contact the Ambulatory Care S tatistics Branch.



## for this report were estimated using SUDAAN software. SUDAAN computes standard errors by using a first-order T aylor series approximation of the deviation of estimates from their expected values. A description of the software and the approach it uses has been published (4). The relative standard error (RSE) of an estimate is obtained by dividing the standard error by the estimate itself. The result is then expressed as a percent of the estimate. When it is not feasible to use statistical software, such as SUDAAN, for analyzing complex survey data, one may calculate approximate RSEs for aggregate estimates using the following general formula, where x is the aggregate of interest in thousands, and A and B are the appropriate coef ficients from table I
. RSE ( x ) = 100 c 

# Œ A + B x 

## Similarly , RSEs for an estimate of a percent may be calculated using the following general formula, where p is the percent of interest expressed as a proportion, and x is the denominator of the percent in thousands, using the appropriate coef ficients from table I
.

# 38 **Advance Data**  **No. 346**  + **August 26,**  **2004**
RSE ( x ) = 100 c 

# Œ B c (1− p ) p c x 

## The standard error for a rate may be obtained by multiplying the RSE of the total estimate by the rate. **Published and**  **flagged estimates**  Estimates are not presented unless a reasonable assumption regarding their probability distributions is possible on the basis of the Central Limit Theorem. This Theorem states that given a suf ficiently lar ge sample size, the sample estimate approximates the population estimate and, upon repeated sampling, its distribution would be approximately normal. In this report, estimates are not presented if they are based on fewer than 30 cases in the sample data; only an asterisk (*) appears in the tables. Estimates based on 30 or more cases include an asterisk only if the RSE of the estimate exceeds 30 percent. **Estimation** Statistics from the NAMCS are derived by a multistage estimation procedure that produces essentially unbiased national estimates. The estimation procedure has four basic components: + inflation by reciprocals of the sampling selection probabilities + adjustment for nonresponse + a population weighting ratio adjustment + weight smoothing Estimates from the NAMCS data were adjusted to account for sample physicians who did not participate in the study
. This was done in a manner that minimized 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. In 2002, the weight from physicians who provided a minimal number of Patient Record forms was capped. The remaining weight for these minimally responding doctors was accounted for by all in-scope, responding doctors in the specialty and PSU. These doctors were counted as nonrespondents in the response rates presented. **Nonsampling errors**  As in any survey , results are subject to both sampling and nonsampling errors. Nonsampling errors include reporting and processing errors as well as biases due to nonresponse and incomplete response. The magnitude of the nonsampling errors cannot be computed. However , these errors were kept to a minimum by procedures built into the operation of the survey . T o eliminate ambiguities and encourage uniform reporting, attention was given to the phrasing of items, terms, and definitions. Also, pretesting of most data items and survey procedures was performed. Quality control procedures and consistency and edit checks reduced errors in data coding and processing. Coding error rates ranged from 0.1 to 1.1 for various data items. Adjustments for survey nonr esponse —The weighted response rate for the 2002 NAMCS was 71.1 percent. T able II presents weighted characteristics of NAMCS respondents and nonrespondents, along with weighted response rates. Distributions were similar , with the exception of region, metropolitan status, physician specialty where internal medicine physicians were less likely to cooperate, and practice type. The ef fect of this dif ferential response is minimized in the visit estimates in most cases as NAMCS uses a nonresponse adjustment factor that takes all of these variables into account, except practice type. Adjustments for item nonr esponse —Item nonresponse rates in the NAMCS are generally low (5 percent or less). However , levels of nonresponse can vary considerably in the survey . Most nonresponse occurs when the needed information is not available in the medical record and/or is unknown to the person filling out the survey instrument. Nonresponse can also result when the information is available, but survey procedures are not followed, and the item is left blank. In this report, the majority of tables include a combined entry of ‘ ‘unknown’ ’ and/or
‘ ‘blank’ ’ t o display missing data. For items where combined item nonresponse is between 30 and 50 percent, percent distributions are not discussed in the text. However , the information is shown in the tables. These data should be interpreted with caution. If nonresponse is random, the observed distribution for the reported item (i.e., excluding causes for which the information is unknown) would be close to the true distribution. However , i f nonresponse is not random, the observed distribution could vary significantly from the actual distribution. Researchers need to decide how best to treat items with high levels of missing responses. For items with a nonresponse greater than 50 percent, data are not presented. W

eighted item nonresponse rates (i.e., if the item was left blank or the
‘ ‘unknown’ ’ box was marked) were 5.0 percent or less for data items with the following exceptions: ethnicity (21.3 percent), was patient referred for this visit (18.4 percent), how many past visits in the last 12 months (5.5 percent), patient’s PCP (5.6 percent), episode of care (9.3 percent), do other physicians share patient’s care for this problem or diagnosis (13.2 percent), and cause of injury (36.8 percent of injury visits). For some items, missing values were imputed by randomly assigning a value from a Patient Record form with similar characteristics and were based on physician specialty , geographic region, and three-digit ICD–9–CM codes for primary diagnosis. Imputations were performed for the following variables: birth year (2.3 percent), sex (5.0 percent), race (16.4 percent), and time spent with physician (13.1 percent). This represents a change from previous survey years when imputations were also performed for the following variables: ethnicity , disposition, and providers seen. Beginning in 1997, these latter items were no longer imputed. Blank or otherwise missing responses are noted in the data. **T**

**ests of**  **significance and**  **rounding** In this report, the determination of statistical inference is based on a two-tailed t -test. The Bonferroni

# Advance **Data No.**  **346** + **August 26,**  **2004** 39 **T**

**able II.**  **Characteristics o**  **f t**  **he 2002**  **National Ambulatory**  **Medical Care**  **Survey ,**  **physician** 

## inequality was used to establish the **respondents and**  **nonrespondents** 

## critical value for statistically significant Number of T o tal sample Responding Nonresponding 

## dif ferences (0.05 level of significance) sampled percent physician physician W e ighted in-scope distribution 3 distribution 4 distribution 5 response 

## based on the number of possible Physician characteristic 1 physicians 2 (weighted) (weighted) (weighted) rate 6 

## comparisons within a particular variable All o f fice-based physicians

....... 2 , 0 9 5 100.0 100.0 100.0 0 .71 1 Age Under 50 years .............. 1 , 0 8 0 5 4
. 1 5 4
. 9 5 1
. 9 0
. 7 2 2 50 years and over ............ 1 , 0 1 5 4 5
. 9 4 5
. 1 4 8
. 1 0
. 6 9 7 Sex M a l e .................... 1 7 1 1 7 9
. 6 7 8
. 6 8 2
. 1 0
. 7 0 2 Female

................... 3 8 4 2 0
. 4 2 1
. 4 1 7
. 9 0
. 7 4 6 Region 7 Northeast

................. 4 7 9 2 1
. 3 1 8
. 2 2 9
. 0 0
. 6 0 7 Midwest

.................. 4 7 3 2 2
. 6 2 3
. 1 2 1
. 2 0
. 7 2 9 South

.................... 6 6 0 3 3
. 3 3 6
. 3 2 5
. 8 0
. 7 7 6 W e s t
.................... 4 8 3 2 2
. 8 2 2
. 3 2 4
. 0 0
. 6 9 5 Metropolitan s tatus 7 MSA area 8

................. 1 , 8 4 8 8 7
. 1 8 5
. 5 9 1
. 2 0
. 6 9 7 Non-MSA area 8

.............. 2 4 7 1 2
. 9 1 4
. 5 8
. 8 0
. 8 0 2 T ype of doctor Doctor of medicine

............ 1 , 9 4 0 9 3
. 8 9 3
. 6 9 4
. 3 0
. 7 0 9 Doctor of osteopathy

.......... 1 5 5 6
. 2 6
. 4 5
. 7 0
. 7 3 4 Specialty 7 General/family practice

......... 3 2 8 1 8
. 4 1 9
. 7 1 5
. 1 0
. 7 6 2 Internal medicine

............. 1 5 6 1 5
. 1 1 2
. 5 2 1
. 6 0
. 5 8 8 Pediatrics

................. 1 5 9 9
. 7 1 1
. 7 4
. 7 0
. 8 6 0 General surgery ............. 1 1 5 3
. 8 4
. 0 3
. 2 0
. 7 5 5 Obstetrics and gynecology

....... 1 2 0 7
. 7 8
. 0 7
. 1 0
. 7 3 4 Orthopedic surgery ............ 1 1 4 4
. 9 4
. 4 6
. 1 0
. 6 3 8 Cardiovascular diseases

........ 1 4 7 4
. 1 3
. 5 5
. 4 0
. 6 1 8 D e r m a t o l o g y ................ 9 2 2
. 1 2
. 3 1
. 7 0
. 7 6 4 U r o l o g y ................... 1 1 5 2
. 1 2
. 1 2
. 2 0
. 7 0 3 Psychiatry

................. 1 5 8 5
. 5 5
. 3 6
. 0 0
. 6 8 3 Neurology

................. 1 6 1 1
. 9 1
. 6 2
. 8 0
. 5 8 4 Ophthalmology

.............. 1 0 5 4
. 4 4
. 1 5
. 1 0
. 6 6 3 Otolaryngology

.............. 1 0 7 2
. 0 1
. 9 2
. 2 0
. 6 7 9 All o ther specialties

........... 2 1 8 1 8
. 4 1 9
. 0 1 6
. 9 0
. 7 3 5 Specialty type 9 P r i m a r y c a r e ............... 7 4 9 5 0
. 0 5 1
. 0 4 7
. 6 0
. 7 2 5 S u r g i c a l

.................. 7 6 5 2 6
. 1 2 4
. 5 3 0
. 0 0
. 6 6 8 Medical

................... 5 8 1 2 3
. 9 2 4
. 5 2 2
. 3 0
. 7 2 9 Practice t ype 7 S o l o ..................... 6 8 5 3 1
. 6 3 1
. 9 3 1
. 0 0
. 7 1 7 T w o physicians

.............. 1 6 7 7
. 5 6
. 9 8
. 9 0
. 6 5 6 Group/HMO 10

............... 7 0 4 3 3
. 9 3 5
. 0 3 1
. 0 0
. 7 3 5 Medical school/government

...... 3 1 1
. 3 1
. 6 0
. 5 0
. 8 8 8 O t h e r .................... 4 2 1
. 8 2
. 2 1
. 1 0
. 8 3 3 Unclassified

................ 4 6 6 2 3
. 9 2 2
. 4 2 7
. 6 0
. 6 6 6
1 Characteristic information i s from t he master files o f t he American Medical Association and the American Osteopathic Association. 2 In-scope physicians are t hose who verified t hat they were non-Federal and involved in direct patient care i n a n o f fice-based setting, excluding the specialties o f r adiology , pathology , and anesthesiology

. 3 T

o tal physicians are t hose who were selected from t he master files o f t he American Medical Association and the American Osteopathic Association. 4 Responding physicians are t hose who were i n-scope and agreed to participate i n t he NAMCS survey . 5 Nonresponding physicians are t hose who were i n-scope and refused to participte in the NAMCS survey . 6 Numerator is the number of in-scope physicians who participated in the NAMCS or who did not see any patients during t heir sampled reporting week. Denominator is all i n-scope sampled physicians. 7 Significant dif f erence in response rate p < .05. 8 MSA is metropolitan s tatistical area. 9 Specialty type is defined in table I V o f t he ‘ ‘ T echnical Notes.’ ’ 10 HMO is health maintenance organization. 

## (or combination of variables) of interest. T

erms relating to dif ferences such as ‘ ‘greater than’ ’ o r ‘ ‘less than’ ’ indicate that the dif ference is statistically significant. A lack of comment regarding the dif ference between any two estimates does not mean that the dif ference was tested and found to be not significant. A weighted least-squares regression analysis was used to determine the significance of trends. For the weighted least-squares test, the null hypothesis is that the slope, β , o f the regression line between the two variables of interest does not significantly dif fer from zero, and the alternative hypothesis is that it does dif fer from zero (i.e., H 0 

## : β =0, and H A 

## : β≠ 0). In this modified least-square regression, each estimate is weighted by the inverse of the standard error (17). In the tables, estimates of of fice visits have been rounded to the nearest thousand. Consequently , estimates will not always add to totals. Rates and percents were calculated from original unrounded figures and do not necessarily agree with figures calculated from rounded data. **Race** The instruction for the race item on the Patient Record form was changed in 1999 to be consistent with standards issued by the Of fice of Management and Budget to promote comparability of data among Federal data sources and so that more than one race could be recorded per person (18). The new race item includes the following groups: white, black or African American, Asian, Native Hawaiian or other Pacific Islander , and American Indian or Alaska Native. Respondents could check multiple categories for each patient. Prior to 1999, only a single race category could be checked per person. Because of the dif ference between single and multiple race reporting, race-specific estimates prior to 1999 are not strictly comparable with those from

# 40 **Advance Data**  **No. 346**  + **August 26,**  **2004** 1999 and subsequent years. From 1999 to the present, only a small proportion of records had multiple races indicated. Where reliable multiple-race estimates can be obtained, they are presented in one category . Estimates for specific race categories reflect visits where only a single race was reported. See
‘ ‘Population figures and rate calculation’ ’ i n the ‘ ‘ T echnical Notes’ ’ for more information. According to the same standards, data on race and Hispanic origin were collected separately
. Consequently , all race categories include visits by persons of Hispanic and not Hispanic origin. Persons of Hispanic origin may be of any race. **Injury groups**  T

able 15 presents data on the intent and mechanism producing the injuries that resulted in visits to physician of

fices. Cause of injury is collected for each sampled visit in the NAMCS and is coded according to the ICD–9–CM’s
‘ ‘Supplementary Classification of External Causes of Injury and Poisoning.’ ’ However , for table 15 , the first-listed cause-of-injury data were grouped to highlight the interaction between intentionality of the injury and the mechanism that produced the injury
. T

able III shows the E-code groupings used to produce this table. **Physician specialty**  **groups** The NAMCS survey design grouped physicians into 15 strata, or specialty groups, for sampling purposes. One stratum, doctors of osteopathy , was based on information from the American Osteopathic Association. The other groups (general and family practice, internal medicine, pediatrics, general sur gery , obstetrics and gynecology , orthopedic sur gery , cardiovascular diseases, dermatology , urology , psychiatry , neurology , ophthalmology , otolaryngology , and a residual category of other specialties) were developed based on information from the American Medical Association (AMA). Estimates are presented in this report with doctors of osteopathy combined with doctors of medicine, unless otherwise noted. T

able IV shows physician specialty groups split into three major categories: primary care, sur gical specialties, and medical specialties based on the AMA classification. **Population figures**  **and rate**  **calculation** The 2002 visit rates for age, sex, race, geographic region, and metropolitan status use Census 2000- based postcensal estimates of the civilian noninstitutional population of the United States as of July 1, 2002, as prepared by the U.S. Census Bureau. Between 1992 and 2000, NAMCS and NHAMCS visit rates used 1990 census-based population estimates. The change in visit rates due to switching from the 1990 census-based population estimates to Census 2000-based population estimates presented in this report for age, sex, and race is minimal. T

o evaluate the ef fect of the change in the base year , the 2000 NAMCS and NHAMCS visit rates were calculated using both the 1990-based population estimates and the 2000-based population estimates. In no case were dif ferences in the two rates statistically significant. It is, therefore, reasonable to conclude that the ef fect of the change in base year has little impact on observed trends that cross these survey years. For more information on rate comparisons, see http://www .cdc.gov/nchs/about/major/ ahcd/ahcd1.htm
.
**T**

**able III.**  **Reclassification o**  **f external**  **cause-of-injury codes**  **for use**  **with National**  **Ambulatory Medical**  **Care Survey**  **data** Intent and mechanism of injury Cause-of-injury code 1 Unintentional injuries

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

F a l l s .................................... Motor vehicle traf fic

........................... Striking against or struck accidentally by objects o r persons . . Overexertion and strenuous movements
.............. Cutting o r p iercing i nstruments o r objects

............. Natural and environmental factors

.................. Poisoning by drugs, medical substances, biologicals, other solid and liquid substances, gases, and vapors ......... Fire and flames, hot substance or object, caustic or corrosive m a t e r i a l , a n d s t e a m .......................... Machinery

................................. Pedal cycle, nontraf fic, and other

.................. Motor vehicle, nontraf fic

........................ Other transportation

........................... F i r e a r m m i s s i l e .............................. Other and not elsewhere c lassified

................. Mechanism unspecified

........................ Intentional injuries

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

Assault

................................... Self-inflicted

............................... Other causes of violence

....................... Injuries o f undetermined intent

..................... Adverse ef fects o f medical treatment
.................. E800–E869, E880–E929 E880.0–E886.9, E888 E810–E819 E916–E917 E927 E920 E900–E909, E928.0–E928.2 E850–E869� E890–E899, E924� E919� E800–E807(.3), E820–E825(.6), E826.1, E826.9� E820–E825(.0–.5,.7–.9)� E800–807,(.0–.2,.8–.9), E826 (.0,.2–.8), E827–E829, E831, E833–E845� E922� E846–E848, E914–E915, E918, E923, E925–E926, E928.3, E928.8, E929.0–E929.5� E887, E928.9, E929.9� E950–E959, E960–E969, E970–E978, E990–E999

E960–E969 E950–E959 E970–E978, E990–E999 E980–E989 E870–E879, E930–E949
1 Based on the ‘ ‘Supplementary C lassification o f External Causes of Injury and Poisoning,’ ’ International Classification o f D iseases, 9th Revision, Clinical Modification (ICD–9–CM) (7).

# Advance **Data No.**  **346** + **August 26,**  **2004** 41 **T**

**able I**  **V .**  **Reclassification o**  **f physician**  **specialty for**  **use with**  **National Ambulatory**  **Medical Care**  **Survey data**  Physician specialty group Physician specialty Primary care specialties

...... Family practice, geriatric medicine (family practice), sports medicine (family practice), general practice, internal medicine/ pediatrics, internal medicine, adolescent medicine, pediatrics, pediatric sports medicine, adolescent medicine (internal medicine), gynecology , maternal and fetal medicine, obstetrics and gynecology , obstetrics, geriatric medicine (internal medicine), and sports medicine (internal medicine). Surgical specialties

......... Hand surgery , adult r econstructive o rthopedics, foot and ankle o rthopedics, musculoskeletal oncology , pediatric orthopedics, orthopedic surgery , sports medicine (orthopedic surgery), o rthopedic surgery o f t he spine, orthopedic trauma, gynecological oncology , u rology , pediatric urology , ophthalmology , pediatric ophthalmology , o tology , o tolaryngology , pediatric otolaryngology , general surgery , critical care medicine (obstetrics and gynecology), abdominal surgery , cardiovascular surgery , colon and rectal surgery , cardiothoracic surgery , facial plastic surgery , head and neck surgery , oral and maxillofacial surgery , plastic surgery w ithin the head and neck, neurological surgery , pediatric surgery ( neurology), pediatric surgery , vascular surgery , plastic surgery , surgical oncology , t horacic surgery , and transplant surgery . Medical specialties

.......... A l l e r g y , addiction medicine, addiction psychiatry , a llergy and immunology , a llergy and immunology/diagnostic laboratory immunology , b ronchoesophageal medicine, cardiology , c linical genetics, clinical biochemical genetics, clinical cytogenetics, clinical molecular genetics, critical care medicine, dermatology , dermatological immunology/diagnostic laboratory

. immunology , d iabetes, emergency medicine, endocrinology , sports medicine (emergency medicine), medical toxicology (emergency medicine), gastroenterology , general preventive medicine, hematology , hepatology , hematology/oncology , cardiac electrophysiology , infectious diseases, immunology , l egal medicine, medical management, medical genetics, neurology , nephrology , nutrition, occupational medicine, medical oncology , c linical pharmacology , pulmonary c ritical care medicine, pediatric emergency medicine (emergency medicine), psychiatry , public health and general preventive medicine, pediatric/diagnostic laboratory i mmunology , palliative medicine, physical medicine and rehabilitation, pain medicine, medical toxicology (preventive medicine), pulmonary diseases, rheumatology , spinal cord i njury , sleep medicine, undersea medicine. 

## Population estimates for race groups in the 2002 NAMCS and NHAMCS are based on Census 2000 where respondents were able to indicate more than one race category (as requested by the 1997 Standards for Federal Data on Race and Ethnicity) (18). The multiple race indication was adopted by the 1999 NAMCS and NHAMCS, but the denominators that were available for calculating rates in 1999 and 2000 were based on estimates from the 1990 census, which indicated single-response race categories. Population estimates for 2000 were not used as denominators for 2000 NAMCS and NHAMCS visit rates because these estimates were not available. In addition, NAMCS and NHAMCS had very few records for multiple-race persons, so rates for single-race groups were calculated by dividing estimates by denominators that included some unidentifiable multiplerace persons. Starting with 2001, the denominators used for calculating race-specific visit rates reflect the transition to multiple-race reporting. Specific race denominators reflect persons with a single race identification, and a separate denominator is available for persons of multiple races. In this report, a visit rate for white persons, for example, uses a denominator that reflects the ‘ ‘white only’ ’ population, and the numerator is the number of visits where white and no other race category was reported as the patient’s race by the health care provider
. Data indicate that multiple races are recorded less frequently in medical records than occur in the general population. The 2002 population estimates indicate that multiple-race persons account for 1.5 percent of the total population, and multiple-race patients (as indicated by the provider) account for 0.3 percent of physician of

fice visits. This dif ference exists because physicians are less likely to know and record the multiple-race preference of the patient and not because, after age adjusting, persons with multiple races make fewer doctor visits. This implies that the race population rates calculated in 2002 are probably slight overestimates for the single-race categories and underestimates for the multiple-race category . The 2002 MSA population estimates based on Census 2000 were not available from the U.S. Census Bureau. They were calculated from data provided by the Of fice of Research Methods and Division of Health Interview Statistics, NCHS, and are based on estimates of the civilian noninstitutionalized population of the United States as of July 1, 2002, using Census 2000 data with adjustments to 2002 totals. 

# Definition **of terms**  Continuity of car e —Continuity of care is a goal of health care achieved through an interdisciplinary process involving patients, families, health care professionals, and providers in the management of a coordinated plan of care. Based on changing needs and available resources, the process optimizes quality outcomes in the health status of clients. It may involve professionals from many dif ferent disciplines within multiple systems. Drug mention —A drug mention is the physician’s entry on the Patient Record form of a pharmaceutical agent—by any route of administration—for prevention, diagnosis, or treatment. Generic as well as brand-name drugs are included, as are nonprescription and prescription drugs. Along with all new drugs, the physician records continued medications if the patient was specifically instructed during the visit to continue the medication. Physicians may report up to six medications per visit. Drug visit —A drug visit is a visit at which medication was prescribed or provided by the physician. Episode of car e —This term attempts to measure the nature of the care provided at the visit, an initial visit versus a followup visit. An episode of care begins with the initial visit for care for a particular problem and ends when the patient is no longer continuing treatment. A problem may recur later , but that is considered a new episode of care. An initial visit may be diagnostic

# 42 **Advance Data**  **No. 346**  + **August 26,**  **2004** in nature, whereas a followup visit may be to check progress or continue therapy
. Followup visit —Care was previously provided for this problem. This is the second or subsequent visit for a problem or complaint. Illness-r elated visit —A visit is considered illness-related if it was not defined as an injury visit as in the definition for an injury-related visit. Initial visit —This is the first visit for care of a particular problem or complaint. Injury-r elated visit —A visit is injury-related if ‘ ‘ Y es’ ’ was checked in response to item 4a, ‘ ‘Is this visit related to injury , o r poisoning, or adverse ef fect of medical treatment?,’ ’ i f a cause of injury or a nature of injury diagnosis was provided, or if an injury-related reason for the visit was reported. In-scope physician —An in-scope physician is a duly licensed doctor of medicine (M.D.) or doctor of osteopathy (D.O.) who is currently in of fice-based practice and who spends some time caring for ambulatory patients. Excluded from the NAMCS are physicians who are hospital-based; who specialize in anesthesiology , pathology , o r radiology; who are federally employed; who treat only institutionalized patients; or who are employed full time by an institution and spend no time seeing ambulatory patients. Office —An o f fice is the space identified by a physician as a location for his or her ambulatory practice. Of fices customarily include consultation, examination, or treatment spaces that patients associate with the particular physician. Patient —A patient is an individual seeking personal health care services who is not currently admitted to any health care institution on the premises. Primary car e physician/pr ovider —A primary care physician/provider (PCP) plans and provides the comprehensive health care of the patient. A visit to the patient’s PCP is one in which health care is provided by the patient’s PCP or by a provider substituting for the patient’s PCP
. Primary car e specialist —A primary care specialist has designated a primary care specialty of general and family practice, internal medicine, pediatrics, etc. Primary care specialists are grouped and presented in table IV of the
‘ ‘ T echnical Notes.’ ’ The terms ‘ ‘primary care specialties’ ’ and ‘ ‘primary care specialists’ ’ are used interchangeably throughout this report and refer to the self-designated classification by physicians in the AMA and AOA masterfiles. Primary expected sour ce of payment —The primary expected source of payment is the source that to the best of the physician or physician’ s staf f ’ s knowledge describes how char ges incurred for this visit will be paid: + Self-pay —Char ges billed directly to the patient that will not be reimbursed by a third party . Does not include prepaid plans for which copayment is char ged. + Medicar e —Char ges paid in part or in full by a Medicare plan, including payments made directly to the hospital as well as payments to the patient. + Medicaid/SCHIP —Char ges paid in part or in full by a Medicaid or State Children’ s Health Insurance Plan (SCHIP), including payments made directly to the hospital as well as payments to the patient. SCHIP , enacted as part of the Balanced Budget Act of 1997, gave States the opportunity to provide free or low-cost insurance coverage to low-income children not otherwise eligible to be covered by Medicaid. States began enrolling children in 1998 using Medicaid or State-specific programs separate from Medicaid, or both. By 2000, all States had implemented their SCHIP programs. + Private insurance —Char ges paid in part or in full by a private insurance company , health maintenance or ganization (HMO) plan or other prepayment plan, including independent practice associations (IP As) and preferred provider or ganizations (PPOs). + No char ge/charity —V isits for which no fee is char ged (not including visits paid for as part of a total care package, e.g., postoperative visits included in a sur gical fee, pregnancy visits for which a flat fee was char ged, and HMO and prepaid systems). + Other sour ces —All other sources of payment not in the preceding categories. Char ges paid under any other local, State, or Federal health care program such as workers’ compensation programs and CHAMPUS. + Unknown —Cases where none of the previous sources of payment categories was checked.

V

isit —A visit is a direct, personal exchange between an ambulatory patient seeking care and a physician or a staf f member working under the physician’s supervision for the purpose of rendering personal health services. Excluded from the NAMCS are encounters where medical care was not provided, such as phone consultations and e-mail consultations, or at visits made to drop of

f specimens, pay bills, or make appointments.

# Advance **Data No.**  **346** + **August 26,**  **2004** 43

**Figure I**  **. Patient**  **Record f**  **orm**

# 44 **Advance Data**  **No. 346**  + **August 26,**  **2004**

**T r**  **ade name**  **disclaimer** The use o f trade names i s f or identification only and does not imply e ndorsement by the Centers f or Disease Control and Prevention, U.S. Department of Health and Human Ser vices.
**Suggested citation**  **Copyright information**  **National Center**  **for Health**  **Statistics** W oodwell DA, Cherry DK. National Ambulatory All material appearing i n t his r eport i s i n t he Director Medical Care Survey: 2002 Summary

. public domain and may be reproduced or Edward J

. Sondik, Ph.D. Advance data from vital and health statistics; no 346. Hyattsville, Maryland: National Center copied without permission; citation a s t o source, however , i s appreciated. Deputy D irector for Health Statistics. 2004. Jack R. Anderson

U.S. DEP AR TMENT OF� HEAL TH & HUMAN SER VICES� Centers f or Disease Control and Prevention� National Center for Health Statistics� 331 1 T oledo Road� Hyattsville, Maryland 20782� OFFICIAL BUSINESS� PENAL TY FOR PRIV A

T E USE, $ 300� T

o receive this publication r egularly , c ontact� the National Center for Health Statistics by� calling 1 -866-441-NCHS (6247)� E-mail: nchsquery@cdc.gov� Internet: www .cdc.gov/nchs� DHHS Publication No. (PHS) 2004-1250� 04-0364 (08/2004)� MEDIA MAIL POST AGE & FEES P AID CDC/NCHS PERMIT NO. G -284