How Much Time Do Patients Spend on Outpatient Visits? The American Time Use Survey

Background: In Crossing the Quality Chasm, the Institute of Medicine recommended that patient-centered care should not waste patients' time and should recognize the involvement of family and friends. Studies have documented the time spent by physicians on outpatient visits, but not that spent by patients and their companions. The patient's perspective provides an important yet overlooked indicator of healthcare effectiveness. Objective: To document how much time American patients spend on outpatient visits, for what purposes (travel, waiting, receiving services), and the time required of family members and friends. Methods: We used data from the first 4 years (2003-6) of the American Time Use Survey (ATUS), conducted by the US Census Bureau for the Bureau of Labor Statistics, which asks respondents about their activities over a 24-hour period. ATUS is a nationally representative population-based survey that samples days continuously throughout the year. In 2003-6, 60 674 respondents aged >= 15 years were randomly selected from households that completed the Current Population Survey; 1621 reported seeking medical care for themselves on their survey day. We documented the percentage of the population that reported outpatient visits, the percentage who were accompanied to those visits and by whom, and the mean time spent by patients and their companions, by type of activity, and by age and sex. Results: After weighting the data to represent the US population, we found that 3.4% of people aged >= 15 years reported traveling, waiting, or receiving services in connection with an outpatient visit on their survey day. The mean time for those who reported the activity was 35 minutes for travel (95% CI 33, 37), 42 minutes of waiting (95% CI 37, 47), and 74 minutes receiving services (95% CI 70, 79). Overall, 39.5% were accompanied, usually by family members. Companions spent a mean of 124 minutes per encounter (95% CI 112, 135). Nearly half of those aged >= 65 years were accompanied, almost always by adults only, suggesting that they may have needed help with transportation, negotiating the healthcare system, or performing cognitive and emotional tasks involved in receiving care. Conclusion: Outpatient visits are time intensive for American patients and their families: the equivalent of 207 million 40-hour work-weeks each year. Patients and their families spend substantially more time on outpatient visits than the time with the physician reported by the annual National Ambulatory Medical Care Survey. Further research is needed on the components of outpatient visits that do not directly involve physicians. Efforts to improve care should address waiting times and recognize the involvement of family members. The ATUS could provide periodic benchmarks of patient time use as a supplement to other indicators of patient-centered care in the annual National Healthcare Quality Report.