COMPARING PATIENTS SEEN IN CONTINUITY CLINICS AND THE NATIONAL AMBULATORY MEDICAL CARE SURVEY (NAMCS): A STUDY FROM THE CONTINUITY RESEARCH NETWORK (CORNET)

JR Serwint¹, KA Thoma², SM Dabrow¹, LE Hunt¹, MS Barratt¹, TR Shope¹, PM Darden¹ for the CORNET Investigators, Ambulatory Pediatric Association, McLean, VA¹,  Department of Practice and Research, Center for Child Health Research, American Academy of Pediatrics, Elk Grove Village, IL.

 

BACKGROUND: CORNET is a national, practice-based research network of resident continuity practices.  Defining visit data from these practices is essential to establishing generalizability and applicability of future studies, as well as the quality of the continuity practices.

 

OBJECTIVES:  To compare visit data from CORNET practices to those described in a national representative sample of pediatric visits, NAMCS.

 

METHODS:  Each CORNET practice collected visit data on a sample of 30 patient visits using the NAMCS methodology during a 1-2 week period of May-August, 2002.  These data were compared to a NAMCS sample of < 22 year old patients seen in pediatric practices during the same time period.  Visit weights were adjusted to reflect the sampling probability and the actual numbers of observations.  Outcomes included patient demographics, presenting symptoms, physician?s diagnoses, and patient management.  All sites entered data onto a secure web-based entry site. 

 

RESULTS:  Eighteen CORNET practices reported on 540 visits which were compared to 32 NAMCS physicians reporting on 792 visits.  CORNET patients were likely to be African-American, 54% vs. 13%; Hispanic, 26% vs. 17%; and to have public insurance, 79% vs. 24%.   Mean age of CORNET patients was 3.9 years compared to 4.8 years with 14% of CORNET patients 10 years or older compared to 19% from the NAMCS survey.  CORNET patients were less likely to be seen for an acute problem, 29% vs. 49%, to be seen by their primary care provider 58% vs. 95%, or to have been seen in the practice before, 89% vs. 96%.  All comparisons were significant at p < .05.  The top 5 reasons for visits were the same between CORNET and NAMCS though the order varied slightly.  These 5 reasons accounted for 58% of visits in CORNET and 50% of visits in NAMCS.

 

CONCLUSIONS:  Residents in CORNET practices see problems that are similar to those in office practices but provide care to more underserved patients.  Patients in the CORNET practices were usually seen by their resident primary care provider although less frequently than in NAMCS practices.  Despite differences in patient populations, continuity clinic visits are remarkable for their similarities to those in office practice. 

 

Funded by the Agency for Healthcare Research and Quality