Chapter 2 The Settings for Health Care Delivery Flashcards
Healthcare delivered in
inpatient or ambulatory
Inpatient settings
general and short term hospitals
long term care facilities such as nursing homes and skilled nursing facilities and others
Ambulatory settings
surgery centers (ASC), medical group practices Community health centers (CHC) dialysis centers urgent care centers retail clinics imaging centers sleep centers catheterization labs vascular access centers telemedicine providers workplace school clinics
A wide range of health care services also delivered in the home
usually less expensive and more convenient for the patient than the care provided in a hospital or skilled nursing facility
The requirements for being a hospital and what services can or cannot be performed in a hospital differ by state, with some commonality due to participation in federal government programs
such as Medicare and Medicaid
Community-based care
self-care/ambulatory care
Hospitals
inpatient acute care
Postacute care
Long term care: adult day care, home health care, hospice, skilled nursing facilities, and residential care facilities
Ambulatory rehabilitation centers
rehab centers
Long-term acute care and other specialty hospitals
Long term and specialty hospitals
Value-based reimbursement puts financial pressure on providers, health care organizations are striving for efficiency, cost control, and sustainability. An increasingly popular strategy to fulfill all these goals is to engage in hospital merger and acquisition activity.
Hospital mergers in 2017 =115
The first half of 2018 = 50
Value-based reimbursements and mergers
Self care the vast majority of people will not receive inpatient acute care in any given year.
An estimated 80% to 95% of health problems are never brought forward to a physician or otherwise involve professional medical care. Frequently ailments perceived to be minor are either addressed with a “take no action”, “wait and see” or self-medication approach.
Fevers, headaches, and indigestion are among the most common ailments treated with non-prescription or “over the counter” medications
Levin and Idler- “Self-care refers to those activities individuals undertake in promoting their own health, preventing their own disease, limiting their own illness, and restoring their own health. These activities and undertaken without professional assistance although individuals are informed by technical knowledge and skills derived from the pool of both professional and lay experience.
Ambulatory care
refers to medical services performed without admission to a hospital or other health care facility for an overnight stay.
Ambulatory care 2.0
physician offices, emergency departments, and hospital outpatient clinics
Ambulatory care settings
Public health clinics
Neighborhood and community health centers
Industrial and other workplace clinics
School health clinics
Emerging and expanding ambulatory settings
telehealth
physician home visits
retail pharmacies
diagnostic imaging and laboratory centers
ambulatory surgery centers and, more generally, ambulatory procedure centers
Urgent care centers
Primary care
is a whole of society approach to health and well-being centered on the needs and preferences of individuals, families, and communities. It addresses the broader determinants of health and focuses on the comprehensive and interrelated aspects of physical, mental, and social health and wellbeing.
Primary care
whole-person care for health needs throughout the lifespan, not just for a set of specific diseases
Primary health care ensures people receive comprehensive care ranging from promotion and prevention to treatment, rehabilitation, and palliative care-as close as feasible to people’s everyday environment.
The primary reason for physician visits in 2016
General medical examination Routine prenatal examination Postoperative visit Medication Cough Well-baby examination Hypertension Knee symptoms Preoperative visit
Hospital emergency departments
are part of a hospital system
The original intention of hospital Emergency departments
A
to take care of acutely ill or injured people
particularly with life-threatening and potentially life-threatening problems that require immediate attention by personnel or equipment not found in private practitioners offices
B
to offer prompt hospitalization if needed
Emergency departments also
serve as a secondary, well-equipped private physician’s office, with more sophisticated resources than are available in a typical doctor’s office.
Another role that became increasingly important after WWII
Have not seen or can not reach their private physician
The regular clinic is not opened when needed
Find that their regular or covering health maintenance organization assigned primary care gatekeeper physician is not available
Geographically out of the region
Have no insurance and no place else to go when sick
Emergency department
considered acute service typically staffed and managed to be ready to treat patients of any acuity the hospital is capable of, most patients who come to the ED will not be admitted and do no have life-threatening illnesses or injuries.
ESI = Emergency Service Index
triage system that uses five levels to triage patients. More than half of ED’s use the esi triage system.
Triage chart on pg 41
One intent of the Affordable Care Act (ACA)
was to reduce unnecessary ED utilization by uninsured people by providing health insurance, better health insurance, and comprehensive primary care that would address the problem.
Statistics regarding utilization of ED on pg 42
Top 10 reasons (2016) for visiting Emergency Department
Stomach and abdominal pain, cramps, and spasms Chest pain and related systems Fever Cough Headache, pain in the head Back symptoms Pain, site not referable to a specific body part Shortness of breath Accident, not otherwise specified Vomitting
Most emergency room visits considered
level 3 urgent on esi or 4 semiurgent on esi
Greatest utilization of emergency departments
was in the West and the lowest in the northeast
OPD
outpatient department
Majority of OPD visits
occur in voluntary hospitals and in government-owned hospitals. The majority of opd visits occur in general medicine clinics. The other top OPD clinic types are: surgery pediatrics obstetrics gynecology
HIstory on clinics
bottom of pg 44
In 1908 the Goshen Hospital was established
Route 17 the road went through the center of the village of Goshen. Traffic accidents occurred with increasing frequency.
10 most common reasons for OPD visits in 2011
Progress visit General medical examination Post operative visit Meditation Counseling Cough Routine prenatal examination Diabetes Symptoms of the throat Well-baby examination
The highest rate of OPD
visits were in the Northeast and the lowest was in the West pg 46
