NHLBI Workshop

Data Needs for Cardiovascular Events, Management, and Outcomes

National Ambulatory Medical Care Survey (NAMCS) - Dr. Jane Sisk

National Ambulatory Medical Care (NAMCS) Scope

• Non-federal, office-based physicians in direct patient care
• Physicians excluded: Anesthesiology, radiology, and pathology
• Out-of-scope settings
  
  • Hospital outpatient clinics, emergency depts.
  • Ambulatory surgicenter
  • Institutional settings (schools, prisons)
  • Federally operated clinic
    

Multistage National Probability Sample

• 3-stage sampling
  • 112 geographic areas
  • 15 strata of physician specialties
    
  • About 30 visits sampled during 1 week
    
• 1,500 physicians participate (about 70%)

Physician Characteristics, 2002

• 55% under age 50
• 21% female
• 20% general/family practice; 13% internal medicine; 4% cardiovascular diseases
• 86% metropolitan statistical area
• 36% south, 18% northeast, 23% Midwest, 22% west
  

Practice Characteristics, 2002

• 34% solo
• 41% single-specialty group
• 73% physician owned
• 17% use electronic medical records
• 84% have managed care contracts
• Average percentage revenue
  
  • 48% private insurance
  • 30% Medicare
  • 12% Medicaid
    

Patient Characteristics

• Age; Gender; Ethnicity/race; Vital signs; Tobacco use; Reason for visit; ZIP
• Expected payment; Continuity; Disease management; Diagnoses.
  

Medical Care

• Diagnostic testing/screening: Physical examination; Blood; Imaging; EKG
• Counseling
• Procedures
• Treatment ordered
• Medications/immunizations
• Providers
• Disposition
• Time with physician
  

How Are the Data Used?

• Management of specific medical conditions
• Quality assessment and monitoring
• Access to care
• Disparities among subgroups
• Diffusion of health-care technologies
• Effects of policy changes
• Benchmarks for states
• Capacity and responsiveness of system
  

Number (in millions) and rate (per 100 persons) of physician office visits for diabetes [Grant et al. Arch Intern Med 2004;164(10):1134-1139]:

Percent of Patients with Hypertension and Diabetes Prescribed an Antihypertensive, by Therapeutic Class, 2001

Continuing Challenges

• Cover changes in technology and delivery
• Obtain richer clinical data
• Track medical management and health outcomes over time
• Cover range of specialties and organizations
• Anticipate and respond to clinical and public policy concerns
  

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