OBJECTIVE:This report compares national estimates for selected health status indicators, health behaviors, health care utilization, health conditions, immunizations, and human immunodeficiency virus (HIV) testing status among selected non-Hispanic Asian adult subgroups. Comparison estimates for the non-Hispanic white, non-Hispanic black, non-Hispanic American Indian or Alaska Native (AIAN), and Hispanic adult populations are also presented.METHODS:The estimates in this report were derived from the Family Core and the Sample Adult Core components of the 2004-2006 National Health Interview Surveys (NHIS), conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics (NCHS). Estimates were generated and comparisons conducted using the SUDAAN statistical package to account for the complex sample design.RESULTS:In general, non-Hispanic Asian adults were least likely to be current smokers, be obese, have hypertension, delay or not receive medical care because of cost, be tested for HIV, or be in fair or poor health compared with non-Hispanic white, non-Hispanic black, non-Hispanic AIAN, or Hispanic adults. Across non-Hispanic Asian subgroups, Vietnamese adults were least likely to have a bachelor's degree or higher and most likely to be poor, be in fair or poor health, and abstain from alcohol use. Korean adults were most likely to be uninsured, be current smokers, and be without a usual place for health care. Japanese adults were most likely to be current moderate or heavier drinkers, and Filipino adults were most likely to be obese.
OBJECTIVEThis report presents Healthy Eating Index (HEI) scores for adults, 60 years of age and over, from the National Health and Nutrition Examination Survey (NHANES), 1999-2002, and examines the association between the HEI scores and sex, age, race and ethnicity, education, smoking status, tooth retention, self-reported health, and body mass index (BMI).METHODSThe percentage of older adults meeting the recommendations for the HEI components and dietary quality based on the overall score were estimated. Means and standard errors were calculated for selected sociodemographic and health characteristics for the total population and stratified by sex. A two-tailed t-test or analysis of variance was used to test the effects of the sociodemographic and health characteristics on the HEI scores. When a characteristic consisted of three levels, the Bonferroni method of adjustment was used to assess significant differences in the mean scores.RESULTSSeventy-two percent of older adults met the guidelines for cholesterol intake and 56% met the recommendation for diet variety, but less than one-third met the recommendations for HEI's five food groups. Only 17% of older adults consumed a "good" quality diet. Males had higher scores for some components, but females had higher scores for others. Age significantly influenced several HEI components, but not in a consistent fashion. Non-Hispanic white persons usually had the highest scores and non-Hispanic black persons had the lowest scores. Adults with more years of education usually had higher scores but smokers usually had lower scores. Edentulous persons and those who rated their health as fair or poor generally ate fewer servings of fruits and vegetables, ate a less varied diet, and had a poorer quality diet than persons with teeth or who rated their health higher. Females with a BMI of 30 or higher ate fewer servings of dairy products, consumed a higher percentage of calories from total and saturated fat, and had a lower quality diet than those whose BMI was less than 30.CONCLUSIONSThis research demonstrates that many older adults' diets need improvement, and that many sociodemographic and health characteristics were associated with their intake of food and nutrient groups and overall dietary quality.
OBJECTIVES This report describes ambulatory care visits to hospital outpatient departments (OPDs) in the United States. Statistics are presented on selected hospital, patient, and visit characteristics. Selected trends in OPD utilization from 1995 to 2005 are also presented. METHODS The data presented in this report were collected in the 2005 National Hospital Ambulatory Medical Care Survey (NHAMCS), a national probability sample survey of visits to emergency and OPDs of nonfederal, short-stay, and general hospitals in the United States. Sample data are weighted to produce annual national estimates. RESULTS During 2005, an estimated 90.4 million visits were made to hospital OPDs in the United States, about 31.0 visits per 100 persons. Females (37.2 per 100 persons) had higher OPD visit rates than males (24.7 visits per 100 persons), and black or African-American persons (56.8 visits per 100 persons) had higher OPD visit rates than white persons (28.3 visits per 100 persons). Visit rates to OPD clinics for preventive care were highest for children under 1 year of age (43.1 per 100 persons). Almost one-half of OPD visits (46.1 percent) were made by patients with one or more chronic conditions. Hypertension was the most frequent chronic condition listed (19.7 percent). Visits with asthma declined with increasing age. From 1995 to 2005, the following visit characteristics changed: The visit rate for children under 15 years of age increased by 38%, the percentage of visits made by adults 18 years and over with depression indicated on the medical record increased by 48%; visits by adults with obesity, diabetes, and hypertension increased by 24%, 34%, and 43%, respectively; visits with counseling for tobacco use increased from 2.7 to 3.8 percent; visits with counseling for diet and nutrition increased from 9.4 to 15.7 percent; and visits with 6 or more medications prescribed or provided more than doubled, from 4.9 to 11.2 percent.
OBJECTIVES:The report uses a multiplicity estimator from a sample of office-based physicians to estimate the number and characteristics of medical practices in the United States. Practice estimates are presented by characteristics of the practice (solo or group, single, or multi-specialty group, size of practice, ownership, location, number of managed care contracts, use of electronic medical records, and use of computerized physician order entry systems).METHODS:Data presented in this report were collected during physician induction interviews for the 2003-04 National Ambulatory Medical Care Survey (NAMCS). The NAMCS is a national probability sample survey of nonfederal physicians who see patients in an office setting in the United States. Radiologists, anesthesiologists, and pathologists-as well as physicians who treat patients solely in hospital, institutional, or occupational settings-are excluded. Sample weights for physician data use information on the number of physicians in the sampled physician's practice to produce annual national estimates of medical practices.RESULTS:During 2003-04, an average of 311,200 office-based physicians practiced in an estimated 161,200 medical practices in the United States. Medical practice characteristics differed from physician characteristics. Although 35.8 percent of office-based physicians were in solo practice, 69.2 percent of medical practices consisted of solo practitioners. The one-fifth of medical practices with three or more physicians (19.5 percent) contains about one-half of all office-based physicians (52.4 percent). About 8.4 percent of medical practices involved multiple specialties. Fifteen percent of medical practices, consisting of 19.0 percent of physicians, used electronic medical records. Similarly, 6.5 percent of medical practices, consisting of 9.2 percent of physicians, used computerized prescription order entry systems.
OBJECTIVE:This report presents national estimates of fall injury episodes for noninstitutionalized U.S. adults aged 65 years and over, by selected characteristics. Circumstances surrounding the fall injury and activity limitations and utilization of health care resulting from the fall injury are also presented.METHODS:Combined data from the 2001-2003 National Health Interview Surveys (NHIS), conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics (NCHS), were analyzed to produce estimates for the U.S. civilian noninstitutionalized population. Data on nonfatal medically attended fall injuries occurring within the 3 months preceding the interview were obtained from an adult family member.RESULTS:The annualized rate of fall injury episodes for noninstitutionalized adults aged 65 years and over in 2001-2003 was 51 episodes per 1,000 population. Rates of fall injuries increased with age, and were higher for women compared with men. Non-Hispanic white older adults had higher rates of fall injuries compared with non-Hispanic black older adults. Older adults with certain chronic conditions and activity limitations had higher rates of fall injuries compared with older adults without these conditions. The most common cause of fall injuries among older adults was slipping, tripping, or stumbling, and most fall injuries occurred inside or around the outside of the home. Nearly 60 percent of older adults who experienced a fall injury visited an emergency room for treatment or advice. Nearly one-third of older adults experiencing a fall injury needed help with activities of daily living as a result, and over one-half of these persons expected to need this help for at least 6 months. A similar percentage experienced limitation in instrumental activities of daily living as a result of fall injuries.CONCLUSION:Fall injuries remain very prevalent among older adults and result in high health care utilization and activity limitations. Rates of fall injuries vary by demographic and health characteristics of older noninstitutionalized adults.
OBJECTIVE:This report presents the most current (2005) nationally representative data on visits to hospital emergency departments (ED) in the United States. Statistics are presented on selected hospital, patient, and visit characteristics. Selected trends in ED utilization from 1995 through 2005 are also presented.METHODS:Data are from the 2005 National Hospital Ambulatory Medical Care Survey (NHAMCS), the longest continuously running nationally representative survey of hospital ED and outpatient department (OPD) utilization. The NHAMCS collects data on visits to emergency and outpatient departments of nonfederal, short-stay, and general hospitals in the United States. Sample data are weighted to produce annual national estimates.RESULTS:During 2005, an estimated 115.3 million visits were made to hospital EDs, about 39.6 visits per 100 persons. This represents on average roughly 30,000 visits per ED in 2005, a 31 percent increase over 1995 (23,000). Visit rates have shown an increasing trend since 1995 for persons 22-49 years of age, 50-64 years of age, and 65 years of age and over. In 2005, about 0.5 million (0.4 percent) of visits were made by homeless individuals. Nearly 18 million patients arrived by ambulance (15.5 percent). At 1.9 percent of visits, the patient had been discharged from the hospital within the previous 7 days. Abdominal pain, chest pain, fever, and cough were the leading patient complaints, accounting for nearly one-fifth of all visits. Abdominal pain was the leading illness-related diagnosis at ED visits. There were an estimated 41.9 million injury-related visits or 14.4 visits per 100 persons. Diagnostic and screening services were provided at 71.1 percent of visits, and procedures were performed at 47.3 percent of visits. Medications were either given in the ED or prescribed at discharge at 76.7 percent of visits, resulting in 204.9 million drug mentions. On average, patients spent 56.3 minutes waiting to see a physician, and 3.3 hours for the full duration of their ED visit. About 12 percent of ED visits resulted in hospital admission. The average total length of stay for those admitted was 5.2 days, and the leading principal hospital discharge diagnosis was nonischemic heart disease.
OBJECTIVES:This report describes ambulatory care visits made to physician offices in the United States. Statistics are presented on selected characteristics of the physician's practice, the patient, and the visit.METHODS:The data presented in this report were collected in the 2005 National Ambulatory Medical Care Survey (NAMCS), a national probability sample survey of visits to nonfederal office-based physicians in the United States. Sample data are weighted to produce annual national estimates of doctor visits.RESULTS:During 2005, an estimated 963.6 million visits were made to physician offices in the United States, an overall rate of 331.0 visits per 100 persons. In one-quarter of office visits, electronic medical records were utilized by physicians, while at 83.9 percent of visits, claims were submitted electronically. As the baby boomer generation aged, there was a shift in utilization, as the majority of visits in 1995 were by patients 25-44 years of age compared with 2005, when most visits were by patients 45-64 years of age. In 2005, 52.7 percent of office visits were made by patients with at least one chronic condition. Hypertension was the most frequent condition (22.8 percent), followed by arthritis (14.3 percent), hyperlipidemia (13.5 percent), and diabetes (9.8 percent). Medication therapy was reported at 679.2 million office visits, accounting for 70.5 percent of all office visits. In 2005, there were about 2.0 billion drugs prescribed, resulting in an overall rate of 210.7 drugs per 100 visits. Drugs with amoxicillin were more likely to be new prescriptions (85.4 percent), while ibuprofen and acetaminophen were just as likely to be a new or continued drug. The overall mean time spent with a physician, excluding psychiatrists, has not changed since 1995; however, visits with a duration of 6-10 minutes decreased by 28% from 1995, while visits lasting 16-30 minutes increased by 20%.
OBJECTIVES This report describes ambulatory care visits to hospital OPDs in the United States. Statistics are presented on selected hospital, patient, and visit characteristics. Selected trends in OPD utilization from 1994 through 2004 are also presented. METHODS The data presented in this report were collected in the 2004 NHAMCS, a national probability sample survey of visits to emergency and outpatient departments of nonfederal, short-stay, and general hospitals in the United States. Selected comparisons are also made with data from the 2004 National Ambulatory Medical Care Survey (NAMCS), a national probability sample survey of visits to office-based physicians in the United States. Sample data are weighted to produce annual national estimates. RESULTS During 2004, an estimated 85.0 million visits were made to hospital OPDs in the United States, about 29.5 visits per 100 persons. Females (35.1 per 100 persons) had higher OPD visit rates than males (23.6 per 100 persons), and black or African American persons (50.3 per 100 persons) had higher OPD visit rates than white persons (27.0 visits per 100 persons). The overwhelming majority of visits to hospital OPDs were made by established patients (85.4 percent). Females made 75.5 percent of preventive care visits. The preventive care visit rate by Hispanic or Latino patients was twice the rate of non-Hispanic patients. Diagnostic and screening services were ordered at 90.3 percent of visits, therapeutic and preventive services were ordered at 50.0 percent of visits, and medications were ordered at 67.4 percent of visits. The proportion of visits involving only midlevel providers increased from 5.9 in 1993-94 to 11.4 percent of visits in 2003-04.
OBJECTIVES:This investigation describes terrorism preparedness among U.S. office-based physicians and their staffs in identification and diagnosis of terrorism-related conditions, training methods and sources, and assistance with diagnosis and reporting.METHODS:The National Ambulatory Medical Care Survey (NAMCS) is an annual national probability survey of approximately 3,000 U.S. nonfederal, office-based physicians. Terrorism preparedness items were added in 2003 and 2004.RESULTS:About 40 percent of physicians or their staffs received training for anthrax or smallpox, but less than one-third received training for any of the other exposures. About 42.2 percent of physicians, 13.5 percent of nurses, and 9.4 percent of physician assistants and nurse practitioners received training in at least one exposure. Approximately 56.2 percent of physicians indicated that they would contact state or local public health officials for diagnostic assistance more frequently than federal agencies and other sources. About 67.1 percent of physicians indicated that they would report a suspected terrorism-related condition to the state or local health department, 50.9 percent to the Centers for Disease Control and Prevention (CDC), 27.5 percent to the local hospital, and 1.8 percent to a local elected official's office. Approximately 78.8 percent of physicians had contact information for the local health department readily available. About 53.7 percent had reviewed the diseases reportable to health departments since September 2001, 11.3 percent had reviewed them before that month, and 35 percent had never reviewed them.
OBJECTIVES:This report presents national estimates of the use of nonfederal short-stay hospitals in the United States during 2005 and selected trend data. Numbers and rates of discharges, diagnoses, and procedures are shown by age and sex. Average lengths of stay are presented for all discharges and for selected diagnostic categories by age and by sex.METHODS:The estimates are based on data collected through the 2005 National Hospital Discharge Survey (NHDS). The survey has been conducted annually by NCHS since 1965. Diagnoses and procedures presented are coded using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM).RESULTS:Trends in the utilization of nonfederal short-stay hospitals show that the overall average length of a hospital stay has declined significantly. In 2005, the average length of stay for all inpatients was 4.8 days compared with 7.8 days in 1970. Stays for discharges aged 15-44, 45-64 and 65 years and over also declined, but the average lengths of stay for those under 15 years of age were the same in 1970 and 2005. In 2005, there were an estimated 34.7 million hospital discharges, excluding newborn infants. Persons aged 65 years and over comprised 38 percent of all inpatients. One notable trend for elderly people is that their rate of hospitalization for septicemia increased 47 percent from 2000 to 2005. There were 45 million procedures performed on inpatients during 2005. Obstetrical procedures (6.9 million) comprised 25 percent of all procedures performed on females. Cesarean section (18 percent), repair of current obstetric laceration (18 percent), and artificial rupture of membranes (14 percent) accounted for one-half of all obstetrical procedures. Males had more cardiovascular procedures than females (4.1 million compared with 2.9 million), whereas females had more operations on the digestive system than males (3.2 million compared with 2.4 million).
OBJECTIVES:This report presents the latest information on the use of electronic medical records in physician offices. Percentages of medical practices and physicians within the practices using electronic medical records (EMR) are presented for 2006 by selected physician and practice characteristics.METHODS:Data from the physician induction interviews of the 2006 National Ambulatory Medical Care Survey (NAMCS) are presented. NAMCS includes a national probability sample of nonfederal office-based physicians who saw patients in an office setting. Sample data were weighted to produce national estimates of physicians. Estimates of medical practices were derived from NAMCS physician data by adjusting the weighting scheme using a multiplicity estimator.RESULTS:In 2006, 29.2 percent of office-based physicians reported using full or partial EMR systems, which represented a 22% increase since 2005 and a 60% increase since 2001, when the NAMCS began monitoring this technology. Starting in 2005, the NAMCS included questions about EMR system features that health information technology experts consider minimal for a comprehensive EMR, namely computerized orders for prescriptions, computerized orders for tests, reporting of test results (lab or imaging), and clinical notes. Based on these requirements, 12.4 percent of physicians surveyed used comprehensive EMR systems in 2006, a figure not significantly different from the 9.3 percent reported for 2005. From 2005 to 2006, the percentage of medical practices using full or partial EMR systems increased by 42% (from 18.3 to 25.9 percent), but the percentage of medical practices using a comprehensive EMR system did not change.
OBJECTIVE:This study presents baseline data to determine which hospital characteristics are associated with preparedness for terrorism and natural disaster in the areas of emergency response planning and availability of equipment and specialized care units.METHODS:Information from the Bioterrorism and Mass Casualty Preparedness Supplements to the 2003 and 2004 National Hospital Ambulatory Medical Care Surveys was used to provide national estimates of variations in hospital emergency response plans and resources by residency and medical school affiliation, hospital size, ownership, metropolitan statistical area status, and Joint Commission accreditation. Of 874 sampled hospitals with emergency or outpatient departments, 739 responded for an 84.6 percent response rate. Estimates are presented with 95 percent confidence intervals.RESULTS:About 92 percent of hospitals had revised their emergency response plans since September 11, 2001, but only about 63 percent had addressed natural disasters and biological, chemical, radiological, and explosive terrorism in those plans. Only about 9 percent of hospitals had provided for all 10 of the response plan components studied. Hospitals had a mean of about 14 personal protective suits, 21 critical care beds, 12 mechanical ventilators, 7 negative pressure isolation rooms, and 2 decontamination showers each. Hospital bed capacity was the factor most consistently associated with emergency response planning and availability of resources.
OBJECTIVE:This report presents statistics on ambulatory care visits to physician offices, hospital outpatient departments (OPDs), and hospital emergency departments (EDs) in the United States in 2005. Ambulatory medical care utilization is described in terms of patient, practice, facility, and visit characteristics.METHODS:Data from the 2005 National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS) were combined to produce averaged annual estimates of ambulatory medical care utilization.RESULTS:Patients in the United States made an estimated 1.2 billion visits to physician offices and hospital OPDs and EDs, a rate of 4.0 visits per person annually. Between 1995 and 2005, population visit rates increased by about 20% in primary care offices, surgical care offices, and OPDs; 37% in medical specialty offices; and 7% in EDs. The aging of the population has contributed to increased volume of visits because older patients have higher visit rates. Visits by patients 40-59 years of age represented about 28.5 percent in 2005, compared with 23.9 percent in 1995. Black persons had higher visit rates than white persons to hospital OPDs and EDs, but lower visit rates to office-based primary care and to surgical and medical specialists. In the ED, the visit rate for patients with no insurance was about twice that of those with private insurance; whereas for all types of office-based care, the visit rates were higher for privately insured persons than for uninsured persons. About 29.4 percent of all ambulatory care visits were for chronic diseases and 25.2 percent were for preventive care, including checkups, prenatal care, and postsurgical care. The leading treatment provided at ambulatory care visits was medicinal with 71.3 percent of all visits having one or more medications prescribed, up by 10% since 1995 when encounters with drug therapy represented 64.9 percent of all visits. In 2005, 2.4 billion medications were prescribed or administered at these visits.
This report presents prevalence estimates for self-reported adult drug use and sexual behaviors in the United States. Data are from the National Health and Nutrition Examination Survey (NHANES) collected from 1999 to 2002. NHANES surveys a stratified multistage probability sample of the civilian noninstitutionalized population of the United States. Tables included in this report present estimates for use of cocaine, including crack or freebase, or other street drugs, and sexual behavior by selected sociodemographic characteristics among adults 20-59 years of age.
OBJECTIVE:This report estimates the prevalence of serious psychological distress (SPD) in the noninstitutionalized adult population of the United States, as measured by the K6 scale of nonspecific psychological distress, and describes the characteristics of adults with and without SPD. These findings are compared with results from previous studies of the characteristics of adults with serious mental illnesses that cause significant disability, such as severe major depression, bipolar disorder, and schizophrenia.METHODS:The estimates in this report were derived from the Family Core and Sample Adult components of the 2001-04 National Health Interview Survey, conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics (NCHS). Estimates were calculated using the SUDAAN statistical package to account for the complex survey design.RESULTS:The prevalence of SPD was higher among adults 45-64 years old than younger adults 18-44 years or older adults 65 years and over. Adults with SPD were more likely to be female, have less than a high school diploma, and live in poverty, and less likely to be married than adults without SPD. Moreover, those with SPD were more likely to be obese and to be current smokers. They have a higher prevalence of ever being diagnosed with heart disease, diabetes, arthritis, and stroke than persons without SPD. Adults with SPD were more likely to report needing help with activities of daily living (ADLs) and instrumental activities of daily living (IADLs). They also used more medical care services such as doctor visits and visits to mental health professionals than adults without SPD.CONCLUSIONS:The associations between SPD and sociodemographic characteristics, health status, and health care utilization are similar to the relationships found between serious mental illnesses (for example, major depression or schizophrenia) and these same variables. Persons with SPD demonstrate disadvantage in both socioeconomic status and health outcomes.
OBJECTIVESThis report describes ambulatory care visits to hospital emergency departments (EDs) in the United States in 2004. Statistics are presented on selected hospital, patient, and visit characteristics. Selected trends in ED utilization from 1994 through 2004 are also presented.METHODSThe data presented in this report were collected in the 2004 National Hospital Ambulatory Medical Care Survey (NHAMCS), a national probability sample survey of visits to emergency and outpatient departments of non-Federal, short-stay, and general hospitals in the United States. Sample data are weighted to produce annual national estimates.RESULTSDuring 2004, an estimated 110.2 million visits were made to hospital EDs, about 38.2 visits per 100 persons. Visit rates have shown an increasing trend since 1994 for persons aged 22-49 years, 50-64 years, and 65 years and over. In 2004, more than 16 million patients arrived by ambulance (15.1 percent). At approximately 3 percent of visits, the patient had been seen in the ED within the last 72 hours. Abdominal pain, chest pain, fever, and back symptoms were the leading patient complaints, accounting for nearly one-fifth of all visits. Abdominal pain was the leading illness-related diagnosis at ED visits. There were an estimated 41.4 million injury-related visits or 14.4 visits per 100 persons. Diagnostic and screening services were provided at 89.9 percent of ED visits. Procedures were performed at 47.7 percent, and medications were prescribed at 78.4 percent of ED visits. Approximately 13 percent of ED visits resulted in hospital admission. On average, patients spent 3.3 hours in the ED, of which 47.4 minutes were spent waiting to see a physician.
OBJECTIVEThis report highlights the health characteristics of four age groups of older adults-55-64 years, 65-74 years, 75-84 years, and 85 years and over-providing estimates by sex, race and Hispanic origin, poverty status, health insurance status, and marital status.METHODSThe estimates in this report were derived from the 2000-2003--National Health Interview Surveys' Family and Sample Adult questionnaires. Estimates are based on interviews with 39,990 sample adults aged 55 years and over.RESULTSOverall, prevalence rates for fair or poor health, chronic health conditions (with the exception of diabetes), sensory impairments, and difficulties with physical and social activities increased with advancing age, doubling or even tripling between the age groups 55-64 and 85 years and over. About one in five adults aged 55-64 years were in fair or poor health, rising to about one-third of adults aged 85 years and over. Men and women were about equally likely to be in fair or poor health across the age groups studied, but women were more likely to have difficulty in physical or social activities. Sociodemographic variations in health were noted across the age groups studied, with the most consistent and striking results found for poverty status and health insurance coverage. Poor and near poor adults and those with public health insurance were, by far, the most disadvantaged groups of older adults in terms of health status, health care utilization, and health behaviors.CONCLUSIONSHealth status, health care utilization, and health-promoting behaviors among adults aged 55 and over vary considerably by age and other sociodemographic characteristics. Identifying these variations can help government and private agencies pinpoint areas of greatest need and greatest opportunity for extending years of healthy life among the Nation's seniors.
OBJECTIVE:This study estimates baseline data to determine which hospital characteristics are associated with providing terrorism preparedness training to clinical staff.METHODS:Information from a Bioterrorism and Mass Casualty Supplement to the 2003 and 2004 National Hospital Ambulatory Medical Care Surveys was used to provide national estimates of variations in terrorism preparedness training by eight hospital characteristics. Of 874 hospitals in scope, 739 (84.6 percent) responded. Estimates are presented with 95 percent confidence intervals.RESULTS:Hospitals with Joint Commission accreditation were more likely to provide terrorism preparedness training to all types of clinical staff (staff physicians, residents, nurse practitioners, physician assistants, and laboratory staff). Teaching hospitals, medical school affiliation, bed capacity, and urban location were also associated with training staff physicians, residents, nurse practitioners, and physician assistants. Hospitals with residency programs were associated with training only staff physicians and residents. There was more parity across hospital characteristics in training nurses and laboratory staff than for physicians, residents, nurse practitioners, and physician assistants. Joint Commission accreditation was the most consistent factor associated with providing training for all nine exposures studied (smallpox, anthrax, chemical and radiological exposures, botulism, plague, tularemia, viral encephalitis, and hemorrhagic fever).
OBJECTIVES:This report describes ambulatory care visits made to physician offices in the United States. Statistics are presented on selected characteristics of the physician's practice, the patient, and the visit. Selected trends in office visits are also presented.METHODS:The data presented in this report were collected in the 2004 National Ambulatory Medical Care Survey (NAMCS), a national probability sample survey of visits to office-based physicians in the United States. Sample data are weighted to produce annual national estimates using an estimator that uses a revised nonresponse adjustment.RESULTS:During 2004, an estimated 910.9 million visits were made to physician offices in the United States, an overall rate of 315.9 visits per 100 persons. Overall, 58.9 percent of visits were to physicians in the specialties of general and family practice, internal medicine, pediatrics, and obstetrics and gynecology. In 2004, primary care specialists provided 87.2 percent of all preventive care visits. The percentage of visits relying on Medicaid or the State Children's Health Insurance Program increased by 36% between 2001 and 2004. Essential hypertension, malignant neoplasms, acute upper respiratory infection, and diabetes mellitus were the leading illness-related primary diagnoses. There were an estimated 105.3 million injury-related visits in 2004, or 36.5 visits per 100 persons. Diagnostic or screening services were ordered or provided at 85.9 percent of visits, and counseling, education, therapeutic, or preventative services were ordered or provided at 42.0 percent of visits. Medications were prescribed or provided at 64.2 percent of visits.
