PDF(Pubmed)
Abstract：
OBJECTIVE: Procedures are manual technical skills clinicians perform for their patients. Family physicians (FPs) acquire these skills during residency; most are undertaken in outpatient settings. We performed a retrospective observational cohort study to describe the extent to which FPs perform the core procedures recommended by the Council of Academic Family Medicine (CAFM) and how this might have changed over time.
METHODS: The CAFM recommended a list of procedures all FP residents should perform competently after graduation. We modified this list for Medicare beneficiaries to enable matching with Current Procedural Terminology codes. We probed Medicare Part B databases for modified CAFM procedure claims submitted by FPs in 2021 and how these claims changed from 2014 to 2021.
RESULTS: In 2021, there were 904,278 modified CAFM procedures filed by 9,410 FPs in the outpatient setting. All procedures were clustered with respect to organ system (eg, musculoskeletal, skin, pulmonary). Beginning in 2014 and continuously through 2021, there was a 33% decrease in outpatient procedures filed and a 36% decrease in the number of FPs filing them.
CONCLUSIONS: Office-based procedures are integral to a primary care physician\'s role, although the activity is rarely analyzed. At a time when the Medicare population is growing, the number of available FPs and the number of procedures they perform are not. This decrease might result from the changing scope of FP practice, new referral patterns, task shifting, and/or increased delegation to physician associates and nurse practitioners.
METHODS: The CAFM recommended a list of procedures all FP residents should perform competently after graduation. We modified this list for Medicare beneficiaries to enable matching with Current Procedural Terminology codes. We probed Medicare Part B databases for modified CAFM procedure claims submitted by FPs in 2021 and how these claims changed from 2014 to 2021.
RESULTS: In 2021, there were 904,278 modified CAFM procedures filed by 9,410 FPs in the outpatient setting. All procedures were clustered with respect to organ system (eg, musculoskeletal, skin, pulmonary). Beginning in 2014 and continuously through 2021, there was a 33% decrease in outpatient procedures filed and a 36% decrease in the number of FPs filing them.
CONCLUSIONS: Office-based procedures are integral to a primary care physician\'s role, although the activity is rarely analyzed. At a time when the Medicare population is growing, the number of available FPs and the number of procedures they perform are not. This decrease might result from the changing scope of FP practice, new referral patterns, task shifting, and/or increased delegation to physician associates and nurse practitioners.
摘要：
目的：程序是临床医生为患者提供的手工技术技能。家庭医生（FP）在住院期间获得这些技能；大多数是在门诊环境中进行的。我们进行了一项回顾性观察性队列研究，以描述FPs执行学术家庭医学委员会（CAFM）推荐的核心程序的程度，以及随着时间的推移，这可能会发生怎样的变化。
方法：CAFM建议所有FP居民毕业后应胜任的程序清单。我们为Medicare受益人修改了此列表，以便与当前程序术语代码匹配。我们调查了MedicareB部分数据库，了解FP在2021年提交的修改后的CAFM程序索赔，以及这些索赔在2014年至2021年期间的变化情况。
结果：在2021年，有904,278个修改的CAFM程序由9,410个FP在门诊环境中提交。所有程序都是针对器官系统进行聚类的(例如，肌肉骨骼，皮肤,肺)。从2014年开始，一直到2021年，提交的门诊程序减少了33％，提交的FP数量减少了36％。
结论：基于办公室的程序是初级保健医师角色不可或缺的一部分，尽管很少对活动进行分析。在医疗保险人口增长的时候，可用FP的数量和他们执行的程序的数量没有。这种减少可能是由于FP实践范围的变化，新的转诊模式，任务转移,和/或增加对医师助理和执业护士的授权。
方法：CAFM建议所有FP居民毕业后应胜任的程序清单。我们为Medicare受益人修改了此列表，以便与当前程序术语代码匹配。我们调查了MedicareB部分数据库，了解FP在2021年提交的修改后的CAFM程序索赔，以及这些索赔在2014年至2021年期间的变化情况。
结果：在2021年，有904,278个修改的CAFM程序由9,410个FP在门诊环境中提交。所有程序都是针对器官系统进行聚类的(例如，肌肉骨骼，皮肤,肺)。从2014年开始，一直到2021年，提交的门诊程序减少了33％，提交的FP数量减少了36％。
结论：基于办公室的程序是初级保健医师角色不可或缺的一部分，尽管很少对活动进行分析。在医疗保险人口增长的时候，可用FP的数量和他们执行的程序的数量没有。这种减少可能是由于FP实践范围的变化，新的转诊模式，任务转移,和/或增加对医师助理和执业护士的授权。
