Annual HMO Research Network Conference
Abstracts from the HMO Research Network |
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important abstract is the first to emerge from the Garfield Memorial
Fund (GMF) study on Best Communication Practices. The study amassed
videotape, audiotape, and pre/post physician and patient questionnaire
data from live physician-patient primary care visits in two regions.
It is one of a collection of five inaugural studies of the GMF
abstract is also part of a collection of abstracts from the 10th
Annual HMO Research Network annual meeting in May 2004, which
will be published this year in The Permanente Journal (TPJ). Several
of these abstracts related to women will appear in the special
Women's Health Winter issue in February 2005. All of these represent
a new feature in TPJ called "Abstracts from the HMO Research
Network." Tom Vogt, MD, FAHA, in his article (page 10), describes
this network. I believe publishing these abstracts creates an
opportunity for Permanente physicians and clinicians to learn
from the research findings in like integrated groups and systems
in other parts of the country.
Tom Janisse, MD, Editor-In-Chief
May 3-5, 2004 Dearborn, MI
Evaluating Care Delivery
Care Visits: Squeezing 22 Minutes into a 19-Minute Visit?
Hee Sung, MPH; John Hsu, MD, MBA, et al.
Balancing patient and provider demands for time during an ambulatory
visit represents a significant clinical and economic challenge. The
study examines actual visit times, patient satisfaction with time spent
with the physician, and time perceptions of patients and physicians.
We collected video and post visit questionnaire data from a convenience
sample of patients and primary care physicians. We examined the time
perceptions of how long physicians were in the exam room, stratified
by whether patients felt they had adequate time with the physician.
Using a mixed linear model, we evaluated differences in time estimates
between the patient, physician, and a researcher watching the video.
Of the 192 patient-subjects, the majority was female (61%) and nonwhite
(59%), with a mean age of 63 years. Most of the 61 physician-subjects
were male (59%) and had 10+ years experience in the health system. Overall,
84% of patients strongly felt that their physician spent enough time
with them during their visit. On average, these patients estimated that
physicians spent 22 minutes in the exam room, whereas physicians estimated
19 minutes and the actual mean time was 19 minutes. In visits where
patients were less satisfied, on average the patients estimated that
physicians spent 19 minutes in the exam room, whereas physicians estimated
20 minutes and the actual mean time was 18 minutes. After adjusting
for age, gender, and clustering by physician, highly satisfied patients
reported significantly more time spent with the physician on average
compared with physicians' estimates or with actual measured time (difference
= 2.6 minutes and 2.4 minutes, p < 0.01). There were no statistically
significant differences in actual visit times by patient satisfaction
or between physician estimates and actual times.
conclusions: Patients who are highly satisfied perceive spending
significantly more time with the physician than actually occurred. In
contrast, less-satisfied patients' time estimates did not differ from
actual times; nor did physician time estimates differ. Similarly, there
were no detectable differences in actual time between visits with various
levels of patient satisfaction. These preliminary results suggest that
there may be methods to help patients feel that they have spent an adequate
amount of time with their physician within the current visit-time constraints.
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