Module 8 lecture, part 1

Question 1

Aspects of outpatient care as compared to ambulatory care

Answer 1

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

Question 2

Aspects of ambulatory care as compared to outpt care

Answer 2

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

Question 3

Since when has there been great growth of oupts svcs in new settings, types, and ownership?

Answer 3

1980s

Question 4

Aspects of primary care in terms of outpt vs ambulatory

Answer 4

The foundation for ambulatory care
All primary care is outpt
Not all outpt care is primary care

Question 5

Settings of outpt svcs

Answer 5

Physician offices
Hospital emergency svcs
Primary care centers
Emergent or urgent care centers
Ambulatory care surgery centers
Community health centers

Question 6

Where is advanced outpt care provided?

Answer 6

Hospital-based medical systems
Integrated delivery orgs

Question 7

Trends in advanced outpt care

Answer 7

Hospital survival depends on ambulatory care
Competition from home health agencies, ambulatory care, urgent care, outpt surgery

Question 8

Aspects of primary care

Answer 8

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

Question 9

What does primary care focus on?

Answer 9

Prevention
Diagnostic
Therapeutic svcs
Health education
Counseling
Minor surgery

Question 10

What types of prevention does primary care include?

Answer 10

Primary
Secondary
Sometimes tertiary

Question 11

What percentage of the general pop requires primary care?

Answer 11

75-85%

Question 12

What are the 3 elements in the WHO definition of primary care?

Answer 12

Point of entry
Coordination of care
Essential care: primary HC as essential HC

Question 13

How is primary care a point of entry into the HC system?

Answer 13

The first contact a pt makes with the delivery system
Role of a gatekeeper

Question 14

Aspects of coordination of care of primary care

Answer 14

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

Question 15

What is the goal of primary care?

Answer 15

To optimize pop health

Question 16

What must be minimized to ensure equal access?

Answer 16

Disparities

Question 17

What aspects of primary care are part of the IOM’s definition?

Answer 17

Integrated
Comprehensive
Coordinating
Continuity: care over time
Accessibility
Accountability

Question 18

Aspects of integration in IOM’s definition of primary care

Answer 18

Comprehensiveness
Coordinated
Continuous
Seamless

Question 19

How is primary care comprehensive according to the IOM?

Answer 19

Combine health services to best meet the pt’s needs

Question 20

How does primary care help with accessibility according to the IOM?

Answer 20

Ease that a pt can interact with a clinician for any health problem

Question 21

Aspects of accountability in primary care according to the IOM

Answer 21

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

Question 22

Reasons for growth in outpt svcs

Answer 22

Changes in reimbursement
Fewer payment restrictions
Development of new tech
Utilization controls by managed care
Social factors

Question 23

Trends in changes in reimbursement for outpt svcs

Answer 23

Constraining inpt svcs
Favoring outpt svcs

Question 24

Where are there fewer payment restrictions in outpt svcs?

Answer 24

Surgery, dialysis, chemotherapy
Paid as fee for service

Question 25

Developments in new tech for outpt- what do they result in?

Answer 25

Less invasive procedures
Quicker recuperation from surgery

Question 26

How have utilization controls by managed care affected outpt growth?

Answer 26

Restriction on utilization, quicker d/c
-Prior auth
-Utilization review

Question 27

How have social factors affected outpt growth?

Answer 27

Preference for obtaining svcs at home or in community-based settings, esp LTC

Question 28

What are the outpt care settings and methods of delivery?

Answer 28

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