Module 8 lecture, part 1 Flashcards
Aspects of outpatient care as compared to ambulatory care
More comprehensive
Outpt svcs: any HC svcs that are not provided on the basis of an overnight stay in which room and board are incurred
Aspects of ambulatory care as compared to outpt care
Care rendered to the “walking” (ambulatory) pts who come to the physician office, clinics, or outpt surgery
Diagnostic and therapeutic
Mobile diagnostic units and home health
Take svcs to pts
Since when has there been great growth of oupts svcs in new settings, types, and ownership?
1980s
Aspects of primary care in terms of outpt vs ambulatory
The foundation for ambulatory care
All primary care is outpt
Not all outpt care is primary care
Settings of outpt svcs
Physician offices
Hospital emergency svcs
Primary care centers
Emergent or urgent care centers
Ambulatory care surgery centers
Community health centers
Where is advanced outpt care provided?
Hospital-based medical systems
Integrated delivery orgs
Trends in advanced outpt care
Hospital survival depends on ambulatory care
Competition from home health agencies, ambulatory care, urgent care, outpt surgery
Aspects of primary care
Plays a central role in a HC delivery system
Basic, routine, continuous, coordinated and comprehensive care
An approach to delivering HC rather than a set of svcs
Address personal HC needs
Develop a partnership with pts
Practice in the context of family and community
What does primary care focus on?
Prevention
Diagnostic
Therapeutic svcs
Health education
Counseling
Minor surgery
What types of prevention does primary care include?
Primary
Secondary
Sometimes tertiary
What percentage of the general pop requires primary care?
75-85%
What are the 3 elements in the WHO definition of primary care?
Point of entry
Coordination of care
Essential care: primary HC as essential HC
How is primary care a point of entry into the HC system?
The first contact a pt makes with the delivery system
Role of a gatekeeper
Aspects of coordination of care of primary care
Delivery of health svs between the pt and the different components of the delivery system
Refer pts to sources of specialized care
Give advice regarding various dx and therapies
Discuss tx options
Providing continuing care of chronic conditions
What is the goal of primary care?
To optimize pop health
What must be minimized to ensure equal access?
Disparities
What aspects of primary care are part of the IOM’s definition?
Integrated
Comprehensive
Coordinating
Continuity: care over time
Accessibility
Accountability
Aspects of integration in IOM’s definition of primary care
Comprehensiveness
Coordinated
Continuous
Seamless
How is primary care comprehensive according to the IOM?
Combine health services to best meet the pt’s needs
How does primary care help with accessibility according to the IOM?
Ease that a pt can interact with a clinician for any health problem
Aspects of accountability in primary care according to the IOM
Clinicians to provide quality care, pt satisfaction, use of resources efficiently, behaving ethically
Pts to be responsible for own health that they can influence and judicious use of resources
Reasons for growth in outpt svcs
Changes in reimbursement
Fewer payment restrictions
Development of new tech
Utilization controls by managed care
Social factors
Trends in changes in reimbursement for outpt svcs
Constraining inpt svcs
Favoring outpt svcs
Where are there fewer payment restrictions in outpt svcs?
Surgery, dialysis, chemotherapy
Paid as fee for service
Developments in new tech for outpt- what do they result in?
Less invasive procedures
Quicker recuperation from surgery
How have utilization controls by managed care affected outpt growth?
Restriction on utilization, quicker d/c
-Prior auth
-Utilization review
How have social factors affected outpt growth?
Preference for obtaining svcs at home or in community-based settings, esp LTC
What are the outpt care settings and methods of delivery?
Private practice
Hospital-based svcs
Freestanding facilities
Retail clinics
Mobile medical, diagnostic, and screening svcs
Home health care
Hospice svcs
Ambulatory LTC svcs
PH svcs
Public and voluntary clinics: community health centers, free clinics
Telephone access
Complementary and alternative medicine
