Frequency and Criticality of Diagnoses in Family Medicine Practices: From the National Ambulatory Medical Care Survey (NAMCS)

Abstract

Background: Family medicine is a specialty of breadth, providing comprehensive health care for the individual and the family that integrates the broad scope of clinical, social, and behavioral sciences. As such, the scope of practice (SOP) for family medicine is extensive; however, over time many family physicians narrow their SOP. We sought to provide a nationally representative description of the most common and the most critical diagnoses that family physicians see in their practice.Methods

Validating the Test Plan Specifications for the American Board of Family Medicine's Certification Examination

“…The relative proportions for each category of the examination that is suggested by the NAMCS frequency data, 6 the Peabody criticality data, 7 and the 5 differently weighted combinations of the 2 are presented in Table 2 and Figure 1. As expected, frequency and criticality represent the ends of the spectrum and the weighted combinations of frequency represented incremental steps from pure frequency to pure criticality.…”

“…From the NAMCS 2012 dataset, 6 the ICD-9 codes seen by family physicians were extracted and the frequency of each code was calculated. These data were used in a previous study by Peabody et al, 7 which categorized the ICD-9 codes into the content categories used on the FMCE by a panel of family medicine subject matter experts. The NAMCS data also provided a patient weight for each visit in their sample, which makes it possible to calculate the frequency of each ICD-9 code in the national population.…”

“…The NAMCS data also provided a patient weight for each visit in their sample, which makes it possible to calculate the frequency of each ICD-9 code in the national population. Peabody et al 7 used these weights to make their frequency of ICD-9 codes representative of physician-patient visits nationally. These nationally representative ICD-9 code frequency weights were also used in this study.…”

Creating a New Blueprint for Abfm Examinations

“…The Index of Harm for the diagnoses listed in NAMCS was assigned by a group of practicing family physicians, and these values were used in studies that evaluated how well the current ABFM blueprint represents both the Index of Harm and frequency, based on the 2012 NAMCS data. 4,5 We expect to use a similar methodology to produce the initial content category weights with the new blueprint.…”

Interventions Must Be Realistic to Be Useful and Completed in Family Medicine

“…The information in the Peabody et al article 15 was collated and assisted by the American Board of Family Medicine (ABFM) certification examination categorizes, and is useful in understanding the content and domain of family medicine. For most family physicians in practice, the diagnoses lists will mirror their everyday practice experiences, and define the breadth (common) or depth (most critical diagnosis) that most represent family medicine.…”