Using NAMCS to characterize the urban health care safety net

Purpose. Data from the National Ambulatory Medical Care Survey (NAMCS) have been used to describe many facets of ambulatory care, but have been underutilized in their application to the urban health care safety net. Our interest was in comparing the visit characteristics of inner city primary care practices in New York City with those of the rest of the country. Methods. Data were collected in 15 primary care centers affiliated with the New York City Research & Improvement Networking Group (NYC RING), a practice-based research network. Physicians completed the cross-sectional survey after patient visits using a slightly augmented version of the standard NAMCS form. Results were then compared with a subset of the Centers for Disease Control and Prevention's public-use dataset for the 2002 NAMCS, selecting only visits to primary care providers and practices in metropolitan statistical areas (N=8,598). Variables of primary interest were visit lengths and diagnoses, adjusting for age and sex. Results. Physicians in NYC RING collected data on 1,861 encounters. Compared with the national sample, our clinicians see 140% more diabetes visits, 70% more hypertension, and 90% more asthma, and provide 88% more dermatologic care and over 300% more reproductive health services. Visits were, on average, one minute longer in our inner city practices (p<.05), and were generally longer across all diagnosis categories than in the national sample. Conclusions. The prevalence of metabolic syndrome and environmentally-related conditions and the provision of more than average specialty care characterize safety net care in New York City.