01-03C - Introduction To Healthcare and Public Health in The US - Unit 03 - Delivering Healthcare Part 2 - Lecture C

Introduction to Healthcare and
Public Health in the US

Delivering Healthcare (Part 2)
Lecture c
This material (Comp1_Unit3c) was developed by Oregon Health and Science University, funded by the Department of Health
and Human Services, Office of the National Coordinator for Health Information Technology under Award Number
IU24OC000015.
Objectives
Describe the organization of clinical healthcare delivery
in the outpatient setting, and the organization of
outpatient healthcare (Lectures a-c)
Describe the organization of ancillary healthcare
delivery in the outpatient setting (Lecture d)
Discuss the role of different healthcare providers, with
an emphasis on the delivery of care in an
interdisciplinary setting (Lecture e)
2
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Delivering Healthcare (part 2)
Lecture c
Outpatient care: Retail Clinics
Facilities usually located in stores or
pharmacies, may also be free-standing
Staffed by nurse practitioners nurses with
additional training
Intended to treat common and minor illnesses
3
Lecture c
Outpatient Care: Urgent Care
Centers
Over 8500 acute care centers in the US
Growing trend since the 1970s
Urgent care centers are usually walk-in
May have extended hours
Usually provide care that may be beyond the
scope of care of typical primary care practice
4
Lecture c
Outpatient Care: Urgent Care
Centers (Continued)
Typically have laboratory and/or X-ray facilities
on-site
Some may have more advanced diagnostic
equipment
Not intended to treat life-threatening
emergencies

5
Lecture c
Outpatient Care: Emergency
Department (ED) or Emergency
Room (ER)
In 1996 there were 90.3 million ER visits
By 2006 the number had risen to 119.2 million
The age group with the highest annual per
capita ER visit rate was infants under 12 months
of age
12.8% (15.3 million ER visits) resulted in
admission to the hospital in 2006

6
Lecture c
Outpatient Care: ED or ER
continued
Emergency rooms (ERs) are intended to treat
life-threatening emergencies
However, a substantial number of ER visits are
for non-emergencies
Approximately 11 percent of all ambulatory
medical care visits in the United States occur in
the ER
The number of non-emergency ER visits may be
very high

7
Lecture c
Effects of Overcrowding In The ER
Delays in the treatment of serious medical
conditions
Increased waiting times
Reduced promptness and quality of pain
management
Hallway boarding of admitted patients
Ambulance diversions
Decreased physician productivity
8
Lecture c
Why so many ER visits?
In our example from upstate New York, 45% of
potentially unnecessary ER cases were seen
between 9 am and 5 pm
Could this be a consequence of the primary
care crisis?
9
Lecture c
Causes of Non-emergency ER
visits
Patients may not have primary care providers
Many primary care clinicians are over-
extended
Lack of insurance is often a barrier to care
Patients with higher rates of chronic medical
conditions may seek a greater proportion of
their care from the ER
10
Lecture c
Reducing Inappropriate ER Visits
Patient education is key
Establish medical homes
Start a telephone triage system
Improve the availability of after hours care
Increase enrollment in safety net programs
Simplify health information
11
Lecture c
Summary Lecture c
Outpatient care settings
Retail clinics
Urgent care centers
Emergency department, emergency room
Problems and solutions regarding overcrowded
emergency rooms
12
Lecture c
References Lecture c
References:
http://www.ucaoa.org/home_abouturgentcare.php
National Center for Health Statistics: "NCHS Data Brief No. 38, May 2010. http://www.cdc.gov/nchs/data/nhsr/nhsr007.pdf
http://www.cdc.gov/nchs/data/nhsr/nhsr007.pdf
https://www.excellusbcbs.com/wps/wcm/connect/c4f1758042992547b080b2dc5c9c0b98/ER+Visits+FS-EX+FINAL.pdf?MOD=AJPERES
Pitts SR, Niska RW, Xu J, Burt CW. National Hospital Ambulatory Medical Care Survey: 2006 emergency department summary. National
health statistics reports; no 7. Hyattsville, MD: National Center for Health Statistics, 2008.
National Center for Health Statistics: "NCHS Data Brief No. 38, May 2010."
http://www.cdc.gov/nchs/data/nhsr/nhsr007.pdf

http://www.ucaoa.org/home_abouturgentcare.php

13
Lecture c

01-03C - Introduction To Healthcare and Public Health in The US - Unit 03 - Delivering Healthcare Part 2 - Lecture C

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Introduction to Healthcare and

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