Characteristics of Primary Care Physicians in Patient-centered Medical Home Practices: United States, 2013

February 17, 2017

Questions for Esther Hing, Survey Statistician and Lead Author on “Characteristics of Primary Care Physicians in Patient-Centered Medical Home Practices: United States, 2013

Q: Can you define what a patient-centered medical home (PCMH) practice is?

EH: One of several PCMH definitions is that PCMHs provide care that is: comprehensive care provided by a team of providers, patient-centered care, coordinated care, has accessible services, and care focused on quality and safety.

Q: Why did you decide to do a report on PCMH practices?

EH: Although the PCMH has been advocated by the “primary care community” for more than a decade, there are no national estimates that describe characteristics of this model of care delivery. “Primary care community” includes primary care physicians as well as other primary care providers and associated professional societies. The report, based on questions funded by the Assistant Secretary for Planning and Evaluation (ASPE), will inform policy makers of the prevalence of certified PCMH practices in the United States, as well as care attributes of these practices (compared with non-PCMH practices).

Estimates not only serve as benchmark estimates for this model of primary care, but adds to the knowledge base about this type of practice. Payers and the federal government have increasingly funded PCMH demonstrations, and certain payers and states have also increased funding to practitioners in PCMH practices.

Q: Is the first time NCHS has published a report on this topic?

EH: Yes, this is the first year that the PCMH questions have been reported.

Q: What did your report find on primary care physicians in PCMH practices?

EH: The report found that primary care physicians in PCMH practices tended to be in larger practices, and located in urban areas. These findings may be attributed to infrastructure requirements needed for PCMH care delivery. It may also reflect that in 2013, the Centers for Medicare and Medicaid Service (CMS) demonstrations and payment policy supporting chronic care was not yet implemented or was in early stages of development.

Q: Were there any findings that surprised you?

EH: The finding that a substantial percentage of non-PCMH practices have non- physician clinicians and Electronic Health Records suggests that there is untapped potential for a greater number of primary care practices to become PCMHs.

However, the relatively lower participation by solo and small practices as PCMHs suggests the need for assistance or coaching to make this transformation. The ongoing implementation of payment incentives from CMS and elsewhere has encouraged growth of PCMHs. This is a trend that the National Ambulatory Medical Care Survey (NAMCS) can be used to examine for the next few years and beyond.


Physician Office Visits for ADHD in Children and Adolescents Aged 4–17 Years: United States, 2012–2013

January 25, 2017

Questions for Michael Albert, Medical Officer and Lead Author on “Physician Office Visits for Attention-deficit/Hyperactivity Disorder in Children and Adolescents Aged 4–17 Years: United States, 2012–2013

Q: Did we learn anything new from this new report about the problem of Attention-deficit/Hyperactivity Disorder (ADHD) among children?

MA: Yes, this report provides a snapshot of health care utilization related to ADHD among children aged 4-17 years. Specifically, it looks at visits to physician offices and uses nationally representative data from the 2012-13 National Ambulatory Medical Care Survey.  Based on a sample of 946 visits by children aged 4-17 years with a primary diagnosis of ADHD, an estimated annual average of 6.1 million physician office visits were made by this age group during 2012-13, corresponding to a visit rate of 105 visits per 1,000 children.

Q:  Does your research back up the notion that boys are more commonly afflicted with ADHD than girls?

MA: Our analysis did find that among children aged 4-17 years with a primary diagnosis of ADHD, the visit rate was more than twice as high for boys as girls.

Q: Is it true that medication is very often involved in the treatment of ADHD?

MA: Central nervous system stimulant medications were provided, prescribed, or continued at approximately 80% of these ADHD visits.  A total of 29% of ADHD visits included a diagnostic code for an additional mental health disorder.  In terms of what specialty of physician provided care at these visits, it was a pediatrician at 48%, psychiatrist at 36%, and general and family medicine physician at 12%.

Q: Was it surprising that 80% of office visits for ADHD involve medication?

MA: It is important to interpret this finding carefully.  Because the National Ambulatory Medical Care Survey is a visit-based survey, as opposed to population based, estimates of persons cannot be made.  Thus, the finding should not be interpreted as indicating that 80% of children aged 4-17 years with ADHD are taking CNS stimulant medications. It is possible that patients taking CNS stimulant medications tend to make more physician office visits than those not taking these medications.  This might be in order to monitor the medication, or for other reasons such as differences in the severity of disease between those who take medication and those who do not.  Although the use of medication in children with ADHD in our survey cannot be directly compared with population-based surveys, there is evidence from the latter that medication is frequently used.  An analysis of parent-reported data from the National Survey of Children’s Health found that among children aged 4-17 years, 69% of children with current ADHD were taking medication for their ADHD (the specific medication was not identified).

Q: Anything else you’d like to address about the report?

MA: Again, we think the significance of this report lies in providing a snapshot of health care utilization related to ADHD in children that is nationally representative.  We chose to investigate several variables to in our analysis that are of interest and provide important information.

State Variation in Preventive Care Visits, by Patient Characteristics, 2012

January 25, 2016

Preventive care visits such as general medical examinations, prenatal visits, and well-baby visits give physicians and other health professionals the opportunity to screen for diseases or conditions, as well as to promote healthy behaviors that may delay or prevent these conditions and reduce subsequent use of emergency or inpatient care.

In an NCHS report, the rate of preventive care visits to office-based physicians is examined by state, patient demographics, and physician specialty. Estimates are based on data from the National Ambulatory Medical Care Survey, a nationally representative survey of visits to office-based physicians.


  • In 2012, 61.4 preventive care visits were made to office-based physicians per 100 persons. The female rate (76.6 visits per 100 females) exceeded the male rate (45.4 visits per 100 males) by 69%.
  • Among the 34 most populous states, the rate of preventive care visits exceeded the national rate in 1 state (Connecticut) and was lower than the national rate in 11 states (Arkansas, Indiana, Iowa, Michigan, Missouri, North Carolina, Oklahoma, Oregon, Pennsylvania, South Carolina, and Washington).
  • The rate of preventive care visits to primary care physicians in the 34 most populous states exceeded the national rate in 1 state (Connecticut) and was lower than the national rate in 7 states (Arkansas, Indiana, Iowa, Missouri, North Carolina, Pennsylvania, and Washington).


Variation in Physician Office Visit Rates by Patient Characteristics and State, 2012

September 11, 2015

An NCHS report examines the rate of physician office visits by patient age, sex, and state. Visits by adults with private insurance as their expected source of payment were also examined.

Estimates are based on the 2012 National Ambulatory Medical Care Survey, a nationally representative survey of physician office visits. State estimates for the 34 most populous states are available for the first time. State refers to the location of the physician office visit.

Key Findings from the Report:

  • In 2012, there were an estimated 301 physician office visits per 100 persons. The visit rate among females exceeded the rate for males.
  • The rate for adults aged 65 and over was more than twice the rate for adults aged 18–64 and children under age 18 years.
  • Among the 34 most populous states, Missouri had the lowest rate of physician office visits for both adult age groups (18–64 and 65 and over), and Connecticut had the highest rate.
  • The percentage of visits made by adults aged 18–64 with private insurance as the expected source of payment varied across the 34 most populous states, ranging from 53% in New York and Arkansas to 79% in Maryland.


Trends in Emergency Department Visits for Ischemic Stroke and Transient Ischemic Attack: United States, 2001–2011

March 31, 2015

Stroke is the fifth leading cause of death in the United States. About 87% of all strokes are ischemic strokes. Transient ischemic attacks (TIAs) cause similar symptoms, but the blockage of blood flow to the brain is temporary. However, about one-third of people who have a TIA will have a stroke within 1 year.

Emergency departments play a critical role in the diagnosis and management of ischemic stroke and TIA. The evaluation of these conditions in the emergency department is similar, so they are combined for this analysis.

A new NCHS report presents recent trends in visits to emergency departments for ischemic stroke or TIA.

Key Findings from the Report:

  • From 2001 through 2011, the rate of emergency department visits for ischemic stroke or transient ischemic attack (TIA) decreased 35% for patients aged 18 and over and 51% for patients aged 55–74.
  • From 2004 through 2011, the percentage of emergency department visits for ischemic stroke or TIA in which the patient arrived by ambulance decreased 41% for patients under 75.
  • The percentage of emergency department visits for ischemic stroke or TIA in which a magnetic resonance imaging (MRI) or computed tomography (CT) test was ordered or provided increased 39% from 2001 through 2011.
  • The percentage of emergency department visits for ischemic stroke or TIA that resulted in admission or transfer to a hospital increased 10% from 2001 through 2011.




Emergency Department Visits and Proximity to Patients’ Residences, 2009–2010

March 19, 2015

The number of emergency department (ED) visits rose 44% from 1991 through 2010, even as the number of hospital EDs declined 10% over the same period.

As a result, EDs have increasingly experienced overcrowding and longer waiting times. Using data from the National Hospital Ambulatory Medical Care Survey, a new NCHS report provides how often patients go to the ED closest to their home, and how differences in geography, patient demographics, and hospital characteristics are associated with ED selection patterns.

Key Findings from the Report:

  • In 2009–2010, visits to emergency departments (EDs) occurred an average 6.8 miles from the patient’s residence, while the nearest ED was 3.9 miles from the home.
  • Less than one-half of all ED visits (43.8%) occurred at the ED closest to where the patient lived.
  • Visits within metropolitan statistical areas were less likely (37.2%) to take place at the closest ED compared with visits outside of metropolitan statistical areas (70.1%).
  • Within metropolitan statistical areas, visits that did not take place at the closest ED occurred more frequently among younger patients, at larger hospitals, and in EDs with longer waiting times, compared with visits to the closest ED.

A brief look at heart disease

February 25, 2009

As a farewell to “American Heart Month,” here’s a brief synopsis of why the heart and its health affects so many of us:

  • Heart disease is the nation’s leading cause of death, responsible for 629,191 deaths in 2006 (National Vital Statistics System, 2006).
  • Heart disease is the nation’s leading diagnosis for hospitalization, at 4.2 million (National Hospital Discharge Survey, 2006).
  • Over 24 million visits to physician offices in 2006 resulted in a diagnoses of heart disease (National Ambulatory Medical Care Survey, 2006).
  • About 11% of U.S. adults have ever been told by a doctor or other health professional they had heart disease (National Health Interview Survey, 2007).
  • About one in six Americans aged 20 years and over has elevated blood pressure and one in four has hypertension (National Health and Nutrition Examination Survey, 2001-2004).