Productivity Analyses of Ambulatory Care Providers: A Method Based on Observational and Informational System Data

摘要

The development of a methodology to examine health manpower productivity in an ambulatory care setting is described. The method involves (a) a small observation study, (b) linkage of times for observed visits to data on diagnosis and patient characteristics from an encounter data information system, and (c) analyses performed for episodes of care for different diagnostic categories. The setting for the study was the Department of Pediatrics in the Columbia Medical Plan, a prepaid group practice HMO. The observation study obtained time data for a sample of visits to physicians and nurse practitioners during a two-week period. Applications of the time data are demonstrated in an analysis of variations in direct patient care times for each provider type. The process of identifying episodes of care for otitis media and sore throat, two common pediatric problems, and calculation of costs related to the episodes are described, and variations in total episode costs are explored. The strengths and limitations of the methodology are discussed.