National Ambulatory Medical Care Survey: Summary
Number 374 June 23, 2006National Ambulatory Medical Care Survey:2004 Summaryby Esther Hing, M.P.H.; Donald K. Cherry, M.S.; and David A. Woodwell, B.A., Division of Health Care StatisticsMusculoskeletal symptomsPsychological and mental disorders35Respiratory symptoms30Percent of visitsPhysician offices are the settings mostfrequently used for health care, includingthe delivery of primary and specialty care.Describing the volume of visits,characteristics of patients making thosevisits, and the contents of the care providedis integral to monitoring the health of theU.S. population and planning for futurehealth care delivery needs. The NationalAmbulatory Medical Care Survey(NAMCS), which began in 1973, collectsdata on the utilization of ambulatorymedical care services provided byoffice-based physicians. It was conductedannually until 1981, again in 1985, andresumed an annual schedule in 1989.For the first time, it is possible topresent seasonal (quarterly) estimates ofphysician office visits. Overall, total visitsto office-based physicians decreasedbetween the second (April–June) and third(July–September) quarter. Visits due tocertain patient complaints or reasons for thevisit also varied by calendar quarter. Forexample, in 2004, visits for symptomsreferable to psychological and mentaldisorders increased during the last fourthquarter (October–December), and morevisits for respiratory symptoms occurredduring the colder months of the first andfourth quarters. Visits for symptoms of themusculoskeletal system decreased in thethird quarter (see figure on this page).This report presents informationabout office-based physician utilizationduring 2004. Additional mberOctober DecemberIncludes visits that occurred December 29–31, 2003 to March 31, 2004.Seasonal variations in selected reasons for visit to physician offices, by calendar quarter:United States, 2004about physician office utilization is available from the Centers for Disease Controland Prevention’s National Center for Health Statistics (NCHS), Ambulatory HealthCare website: http://www.cdc.gov/nchs/namcs.htm.Individual-year reports and public-use data files are available for download from thewebsite. Data from the 2004 NAMCS will also be available on CD-ROM. These andother products can be obtained from the NCHS Office of Information Services,Information Dissemination Staff at 301-458-INFO, 1-866-441-NCHS (6247), theAmbulatory Care Statistics Branch at 301-458-4600, or by e-mail atNCHSquery@cdc.gov.U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICESCenters for Disease Control and PreventionNational Center for Health Statistics
2Advance Data No. 374 June 23, 2006AbstractIntroductionObjectives—This report describesambulatory care visits made tophysician offices in the United States.Statistics are presented on selectedcharacteristics of the physician’spractice, the patient, and the visit.Selected trends in office visits are alsopresented.Methods—The data presented inthis report were collected in the 2004National Ambulatory Medical CareSurvey (NAMCS), a nationalprobability sample survey of visits tooffice-based physicians in the UnitedStates. Sample data are weighted toproduce annual national estimatesusing an estimator that uses a revisednonresponse adjustment.Results—During 2004, anestimated 910.9 million visits weremade to physician offices in theUnited States, an overall rate of 315.9visits per 100 persons. Overall,58.9 percent of visits were tophysicians in the specialties of generaland family practice, internal medicine,pediatrics, and obstetrics andgynecology. In 2004, primary carespecialists provided 87.2 percent of allpreventive care visits. The percentageof visits relying on Medicaid or theState Children’s Health InsuranceProgram increased by 36% between2001 and 2004. Essential hypertension,malignant neoplasms, acute upperrespiratory infection, and diabetesmellitus were the leading illnessrelated primary diagnoses. There werean estimated 105.3 million injuryrelated visits in 2004, or 36.5 visitsper 100 persons. Diagnostic orscreening services were ordered orprovided at 85.9 percent of visits, andcounseling, education, therapeutic, orpreventative services were ordered orprovided at 42.0 percent of visits.Medications were prescribed orprovided at 64.2 percent of visits.The National Ambulatory MedicalCare Survey (NAMCS), which began in1973, was inaugurated to gather,analyze, and disseminate informationabout the health care provided byoffice-based physicians. Ambulatorymedical care is the predominant methodof providing health care services in theUnited States and occurs in a widerange of settings. The largest proportionof ambulatory care services occurs inphysician offices (1). NAMCS is part ofthe ambulatory component of theNational Health Care Survey, a familyof surveys that measures health careutilization across various types ofproviders. More information about theNational Health Care Survey can befound at the Centers for DiseaseControl and Prevention’s NationalCenter for Health Statistics (NCHS)website: www.cdc.gov/nchs.The format for this report wasstreamlined from that used in prior yearsby condensing the informationpreviously found in the ‘‘Results’’ and‘‘Technical Notes’’ into the‘‘Highlights’’ and ‘‘Methods’’ sections.The report presents national annualestimates of physician office visits usingan estimator with a revised nonresponseadjustment. Prior to 2003, theadjustment accounted for nonresponseby physician specialty, geographicregion, and metropolitan statistical areastatus. However, research conductedwith 2003 data showed that physicianswith larger visit volumes were morelikely to refuse to participate. Inaddition, physicians who did not seepatients during their assigned week sawpatients fewer weeks annually thanphysicians who did see patients (2).Beginning in the 2003 data year, theadjustment also accounted fornonresponse from physicians by practicesize (as measured by number of weeklyvisits) and for variability in number ofweeks participating physicians sawpatients during the year (2). Becausevisit estimates using the revisedestimator are expected to be higher inmagnitude than estimates using theprevious estimator when there is greaternonresponse from physicians withgreater volume, trend comparisons ofKeywords: ambulatory care cphysician office care c diagnoses cinjury c medications c ICD–9–CM cprimary carevisits and visit rates were analyzedseparately for 1994–2001 using theoriginal weight and for 2001–2004 usingthe revised weight (2) (see ‘‘Methods’’section). Other Advance Data FromVital and Health Statistics reportshighlight visits to hospital OPDs (3) andEDs (4). Detailed reports on medicationuse at physician office visits andphysician-level estimates for the UnitedStates are forthcoming. NAMCS datahave been used in articles examiningimportant topics of interest in publichealth and health services research(5–16).HighlightsPhysician office utilization Between 1994 and 2001, the numberof visits made to physician officesincreased by 29% (from 681.5 to880.5 million visits), but was stablebetween 2001 and 2004. In 2004, anestimated 910.9 million annual visitswere made to physician offices.According to the American MedicalAssociation, the number of officebased physicians in the United Statesincreased by about 32% percentbetween 1994 and 2004 (17,18). There were on average about 315.9visits to U.S. physician offices forevery 100 persons during 2004. From 1994 through 2004, the overallvisit rate per population increased by14%, from 262.5 to 300.4. About 82 percent of office-basedphysicians were located inmetropolitan statistical areas (18), butthey provided 86.8 percent of annualphysician office encounters (Table 1).Physician practicecharacteristics About one-quarter of all visits wereto general and family practicephysicians, with an additional36.1 percent of visits to physiciansspecializing in internal medicine,pediatrics, and obstetrics andgynecology (Figure 1). Visits are also presented by specialtytype, a grouping of specialties andsubspecialties split into three majorgroups: primary care, surgical, andmedical specialties (see ‘‘Physician
Advance Data No. 374 June 23, 2006General and family medicineAll others3no insurance (104.3 per 100 personswith no insurance) (Figure 5).Continuity of care22.8%31.1%16.1%4.8%Internal medicine5.2%Orthopedic surgery7.2%12.8%OpthalmologyPediatricsObstetrics and gynecologyFigure 1. Percent distribution of office visits by physician specialty: United States, 2004specialty groups’’ in ‘‘Methods’’). In2004, 58.5 percent of office visitswere made to primary carespecialists, 19.4 percent to surgicalspecialists, and the remaining22.2 percent to medical specialists. Overall, 86.9 percent of the visitswere to physicians who owned thepractice themselves or owned it witha group of other physicians. Themajority of office visits (64.9 percent)were made to physicians engaged ingroup practice (Table 2). More than one-half of all visits wereto physicians in practices with 2 to 9physicians (52.8 percent) comparedwith 12.0 percent of visits to largepractices with 10 or more physicians. One-third of visits were to solopractitioners, 41.2 percent were tosingle-specialty group practices, and23.7 percent were to multispecialtygroup practices (Table 2). Patient characteristics Infants under 12 months of age had avisit rate of 665.4 visits per 100persons (Table 3). Although visit rates increasedbetween 1994 and 2001 for persons22–49 years old (up by 12 percent),50–64 years old (up by 26 percent),and 65 years old and over (up by29 percent) (Figure 2), rates for these age groups were stable between 2001and 2004.The visit rate for non-Hispanic whitepersons exceeded the visit rate fornon-Hispanic black, Hispanic orLatino, and Asian persons (Figure 3).Private insurance was the mostfrequently recorded expected sourceof payment, accounting for56.0 percent of visits. Medicareaccounted for 22.7 percent of visits,Medicaid or State Children’s HealthInsurance Program (SCHIP)accounted for 9.8 percent of visits,and no insurance (which includesself-payment, charity, and no charge,but excludes patient copayments anddeductibles) accounted for 4.8 percentof visits (Table 4).The percentage of visits with privateinsurance as the expected source ofpayment increased by 11% between1997 and 2001, but decreased by 5%between 2001 and 2004. Since 2001,the percentage of office visits relyingon Medicaid or SCHIP for paymentincreased 36% (Figure 4).The visit rate for Medicare patients(575.4 per 100 persons withMedicare) was higher than those withMedicaid or SCHIP (294.1 per 100persons with Medicaid or SCHIP),private insurance (263.4 per 100persons with private insurance), and In 47.1 percent of physician officevisits, the provider indicated that theywere the patient’s primary carephysician or provider (PCP);48.2 percent were to physicians otherthan the patient’s PCP, and at4.7 percent of visits it was unknownif the physician was the PCP(Table 5). Of the visits to physicians other thanthe patient’s PCP, about one-third(29.8 percent) were referrals(calculated from Table 5). Visits bynew patients were more likely to bereferrals than visits made byestablished patients (44.1 percentversus 10.6 percent). Among visits to non-PCPs, thespecialties with visits most frequentlyreferred by other physicians wereneurology (52.0 percent), generalsurgery (49.7 percent), and orthopedicsurgery (38.5 percent). More thanone-half of visits to ophthalmologists,dermatologists, psychiatrists, andurologists were self-referrals(Table 6). Established patients accounted for88.8 percent of office visits. Fourfifths of office visits (82.1 percent)were made by established patientswho had at least one previous visit inthe last 12 months, and 25.4 percenthad six or more visits in the previous12 months (Table 7). New patientsaccounted for 11.2 percent of visitsrepresenting a 32% decrease since1994 (16.4 percent). Surgical care specialists (31.0 percent)and medical care specialists(29.7 percent) were more likely toshare care with other physicianscompared with primary carespecialists (19.4 percent) (Table 7).Conditions seen In 2004, symptom complaintsaccounted for one-half of all officevisits. Some of the more prominentsymptoms included musculoskeletal(10.1 percent), respiratory(8.6 percent), and symptoms referableto psychological and mental
4Advance Data No. 374 June 23, 20061,000800Number of visits per 100 personsUnder 1 yearUnder 1 year6004001–12 years1–12 years20013–21 years019941995199613–21 years1997199819992000200120022003200480065 years and overNumber of visits per 100 persons70060065 years and over50050–64 years40050–64 years30022–49 years22–49 04NOTES: 1994–2001 trends for ages 22–49 years, 50–64 years, and 65 years and over are significant (p 0.05).Solid lines represent estimates using original weight. Dotted lines represent estimates using revised weight thatinclude adjustment for variation in the typical number of weeks worked annually and for variation in visit volumein a work week. The weight for 2000 and earlier do not include this adjustment. Original weight not available for2004. For details, see “Methods.”Figure 2. Trends in office visit rates by patient age: United States, 1994–2004disorders, which accounted for3.3 percent of all visits (Table 8). General medical examination(6.2 percent) was the most frequentlymentioned specific reason for visit,and cough (2.8 percent) was the mostfrequently mentioned reasonregarding an illness or injury(Table 9). Acute problems and routine chronicproblems each accounted forone-third of the visits (Table 10). Thepercentage of visits for acuteproblems declined with patient age,whereas the percentage of visits forchronic conditions increased withpatient age. Approximately 16.1 percent of allvisits were for preventive care. Ahigher percentage of visits by femaleswere for preventive care comparedwith visits by males. The visit rate byfemales for preventive care wassignificantly higher (67.6 per 100persons) than the rate for males (33.6visits per 100 persons) (Table 11).The preventive care visit rate amonginfants under 1 year of age (306.8)exceeded that of all other age groups.Uninsured persons (as measured byself-pay and charity visits) had amuch lower preventive care visit ratecompared with persons with privateor public health insurance, placingthem at a disadvantage for diseaseprevention and early diagnosis. The primary physician diagnosis for17.9 percent of visits involved thesupplementary classification, used fordiagnoses that are not classifiable toinjury or illness (for example, generalmedical examination, routine prenatalexamination, and health supervisionof an infant or child) (Table 12). The most frequent illness diagnosesfor office visits were essentialhypertension, malignant neoplasms,acute upper respiratory infections(excluding pharyngitis), diabetesmellitus, arthropathies and relateddisorders, and spinal disorders(arthritis) (Table 13). The leading diagnoses by age are:infants (under 1 year) and children(1–12 years)—routine infant or childhealth check; adolescents throughadults (13–49 years)—normalpregnancy; middle-aged persons(50–64 years) and seniors (65 yearsand over)—essential hypertension(Table 14). Although normal pregnancy leads thelist among all adolescents 13–21years of age and adults 22–49 yearsof age, the leading diagnoses formales in these age groups wereroutine infant or child health check
Advance Data No. 374 June 23, 200645095% confidence interval400Number of visits per 100 persons350300250200150100500White, notHispanicBlack, notHispanicHispanicAsianRace and ethnicityFigure 3. Annual rate of visits to office-based physicians by patient race and ethnicity:United States, 2004Private insurance1Medicaid or SCHIP 2No insurance 3MedicareOther or unknown6050Percent of Trends from 1997 to 2001 and from 2001 to 2004 were significant (p 0.05).SCHIP is State Children’s Health Insurance Program. Trend from 2001 to 2004 is significant (p 0.05).No insurance includes self-pay, no charge, or charity. Trend from 2001–04 is significant (p 0.05).NOTES: 2001–04 percentages computed with revised weight. The revised weight includes adjustment for variation in thetypical number of weeks worked annually and for variation in visit volume in a work week, whereas the weights for 2000and earlier do not. Percentages computed using the revised estimator were only slightly affected. For details, see“Methods.”Figure 4. Trend in percentage of office visits by expected source of payment: UnitedStates, 1997–2004(13–21 years of age) and spinaldisorders (22–49 years of age)(Table 14). In 2004, there were an estimated105.3 million injury-related officevisits, representing 11.6 percent of all(73.6 visits per 100 persons) wasapproximately double that of agegroups under 45 years of age. Theinjury rate for non-Hispanic ornon-Latino persons (38.9 visits per100 persons) exceeded the injury ratefor Hispanic or Latino persons (22.0per 100 visits). Intent and mechanism associated withinjury-related visits is a key dataitem, but nonresponse for cause ofinjury is high at 36.2 percent(Table 16). The distributions providedcould change significantly if missingdata are not random.Services providedNOTES: Persons of Hispanic origin may be of any race. Asian race includes persons of Hispanic and non-Hispanic origin.705visits and yielding a rate of 36.5visits per 100 persons (Table 15).Starting at age 15 years, the injury related visit rate increasedsignificantly with patient age. Therate for patients 75 years and over Diagnostic or screening services wereprovided at 85.9 percent of visits. Themost frequently occurring diagnosticservice was a general medicalexamination (50.5 percent) (Table 17).Imaging was ordered or provided at10.0 percent of visits; the majority ofimaging services were x rays. Visitsby females were more likely to haveimaging performed compared withvisits by males, a difference duemostly to mammographies. Visits byfemales were also more likely to haveurinalysis performed compared withvisits by males, but males were morelikely to have an EKG or lipids orcholesterol tests performed comparedwith visits by females. The patient’s temperature was takenat 26.4 percent of visits. The averagetemperature was 99.2 F at visitswhere fever was the reason for visit(Table 18). The patient’s bloodpressure was measured at52.4 percent of visits. When thediagnosis was essential hypertension,the mean systolic blood pressure was138.9 mmHg and the diastolic bloodpressures was 80.3 mmHg. Counseling, education, or therapeuticservices were ordered or provided at42.0 percent of visits (Table 19). Themost frequent counseling or educationprovided at office visits related to dietor nutrition (12.8 percent) andexercise (8.7 percent). Surgical procedures were ordered orprovided at 7.7 percent of visits (datanot shown). An estimated 79.9million ambulatory surgical
6Advance Data No. 374 June 23, 2006MethodsNumber of visits per 100 persons1700Data collection60095% confidence interval5004003002001000MedicareMedicaid or2SCHIPPrivateinsuranceNo insurance31Denominator for each rate is the population total for each type of insurance obtained from the2004 National Health Interview Survey.2SCHIP is State Children's Health Insurance Program.3Includes self-pay and no charge or charity.Figure 5. Annual rate of visits to office-based physicians by primary expected source ofpayment: United States, 2004procedures were ordered, scheduled,or performed during office visits(Table 20).Medications Medication therapy was reported at585.2 million office visits, accountingfor 64.2 percent of all office visits(Table 21). Multiple drugs wererecorded at 38.8 percent of all visits;in 4.3 percent of visits, eight or moredr
Ambulatory Care Statistics Branch at 301-458-4600, or by e-mail at NCHSquery@cdc.gov. characteristics of patients making those visits, and the contents of the care provided is integral to monitoring the health of the 30 U.S. population and planning for future health care delivery needs. The National Ambulatory Medical Care Survey
visit characteristics using data collected in the 2015 National Hospital Ambulatory Medical Care Survey (NHAMCS). NHAMCS is an annual nationally representative sample survey of visits to EDs; outpatient departments; and hospital-based ambulatory surgical centers (ASCs) (sta
nationally representative data on ambulatory care visits to hospital emergency departments (EDs) in the United States. Estimates are presented on selected hospital, patient, and visit characteristics using data collected in the 2017 National Hospital Ambulatory Medical Care Survey (NHAMCS).
physician offices in the United States. Statistics are presented on physician practices as well as patient and visit characteristics using data collected in the 2018 National Ambulatory Medical Care Survey (NAMCS). NAMCS is an annual nationally representative sample survey of visits to nonfederal office-based patient care
Number 338 August 5, 2003 National Hospital Ambulatory Medical Care Survey: . (84.2 percent); 70.0 percent had visited the clinic one or more times during the past 12 months. Preventive care visits . July 1, 2001. These population estimates are based on postcensal estimates from
Internal medicine General and family medicine 29.2% 22.4% 17.4% 13.4% 6.7% 6.1% 4.8% SOURCE: CDC/NCHS, National Ambulatory Medical Care Survey. Figure 1. Percent distribution of office visits by physician specialty: United States, 2005 2 Advance Data No. 387 June 29, 2007
Ambulatory Infusion Pump Kit REF Description 350-1000 1 - Curlin 4000 Plus Ambulatory Infusion Pump 2 - “C” size alkaline batteries 1 - AC power adapter/charger 1 - Hard carrying case 1 - User’s Manual 4000 Plus Ambulatory Infusion System EASY TO USE EASYTO SETUP SOP
Jan 01, 2021 · Code Ambulatory Surgical Center Services Fee Schedule 2021 The Ambulatory Surgical Center fee schedule does not have rates listed due to reimbursement though . 11750 11755 11760 11762 11765 Ambulatory Surgical Center Fee Schedule 2021 Page 3. Code
dan kinetik dari neuromuskuloskeletal tulang belakang (1,2,3). II. Anatomi Tulang Belakang Lumbosakral 2.1 Elemen-Elemen Tulang 2.1.1 Vertebrae Lumbal Ukuran tulang vertebrae lumbal semakin bertambah dari L1 hingga L5 seiring dengan adanya peningkatan beban yang harus disokong. Pada bagian depan dan sampingnya, terdapat sejumlah foramina kecil untuk suplai arteri dan drainase vena. Pada bagian .
