Development of a method for the analysis of the utilization of resources in an ambulatory care setting

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Abstract

FNS is a primary health care service and training center headquartered in Leslie County of eastern Kentucky, an area that covers 1000 square miles with a population of approximately 15,000. FNS currently operates a forty-bed hospital with outpatient facilities, seven district nursing outposts, and an administrative headquarters. The FNS staff, as of January 1, 1975, included four physicians and forty-two nursing personnel (e.g., nurse midwives, family nurse practitioners, registered nurses). Hence, the nurse, rather than the physician forms the core of the service. Over the past three years, FNS has collected information on the outpatient visits of its patients through the use of an encounter form. An encounter form is filled out for each outpatient visit at FNS made either at the hospital clinics, the hospital emergency room, the district outposts, or the patient's home. This research used the encounter information on 57,954 outpatient encounters and was sent to this researcher in the form of computer tapes. The first stage analysis is comprised of a multivariate contingency table analysis that tests simple hypotheses and indicates the proper selection of variables for inclusion in the second stage analyses. The second-stage analyses use an interactive data analysis system, AUTOGRP, to perform a stepwise, nonsymmetrical branching technique based on variance reduction which yields insight into higher-order interaction effects. AUTOGRP offers a simple clustering alternative to linear regression. Results from the first stage analyses indicate that variation in treatment patterns was significantly affected by the nature of the delivery setting for the two acute, self limiting problems of otitis media and tonsillitis/pharyngitis. However, variation in treatment patterns was significantly affected by the skill level of the provider for the acute/chronic condition, urinary tract infection. Evaluation of the use of an encounter form as a source of information is also considered. It was concluded that a well-designed encounter form is virtually as valid a source as the medical record when analyzing resource use in a primary care environment. Uses of the FNS encounter form for accounting, planning, and research purposes are documented.

Original languageEnglish (US)
JournalAbstracts of Hospital Management Studies
Volume14
Issue number2
StatePublished - Jan 1 1977
Externally publishedYes

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