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Outpatient Services and
Primary Health Care
Christy Harris Lemak, Ph.D
Associate Professor
Health Services Administration
Overview for Today
 Outpatient Care
 Primary Care
 What are key issues?
Some Key Terms
 Outpatient Services
 Ambulatory Care
 Primary Care
Definitions
 Outpatient Services = those that do not
require overnight hospital stay.
 Ambulatory Services = services pr...
Where is Outpatient Care Provided?
 Physician offices
 Hospital outpatient departments
 Diagnostic (e.g. lab, radiology...
Outpatient Care = Growth!
 All trend lines are up, up, up
 Why?
 Reimbursement changes
 Payments
 Utilization control...
Important Considerations
 Outpatient services are delivered….
 In a variety of settings
 By various types of providers
...
Some Trends to Watch
 Telephone and Email visits
 Group visits
 Use of the Internet in various ways
 Information (gene...
The Health Services System
 Preventive Care
 Primary Care
 Secondary Care
 Tertiary Care
 Restorative Care
 Continui...
The Health Services System
 Preventive Care
 Primary Care
 Secondary Care
 Tertiary Care
 Restorative Care
 Continui...
Understanding Primary Care
 Primary Care
 Secondary Care
 Short-term, sporadic consultation from a specialist
for exper...
Two Dimensions to Consider
 Type of Care
 Preventive ----- Continuing
 Location of Care
 Inpatient --- Outpatient
 Wi...
Primary Care
 Three key elements
 Point of Entry
 Coordination of Care
 Essential Care
Point of Entry
 First contact with health care system
 Gatekeepers
 Patients come “through” primary care
physicians to ...
Coordination of Care
 PCPs coordinate delivery of care from
many sources
 Patient advisors, patient advocates
 Ensure c...
Essential Care
 Meeting needs to optimize population
health
 What is population health?
 Why do we care?
Ideal Attributes of Primary Care
 Integrated
 Coordinating
 Continuity of care
 Accessibility
 Remove barriers of geo...
Who Provides Primary Care?
 Physicians
 Doctors
 Extenders
 Nurses
 Ancillary
 Alternative
Physicians
 PCPs (Primary Care Physicians)
 Typically…
 Family Practice
 General Internal Medicine
 Pediatrics
 Obst...
PCP Trends
 Historically
 over-supply of specialists
 Bias towards specialists and sub-specialists
 Follow the money
...
Doctors
 Allopathy
 Osteopathy
 Optometry
 Psychology
 Podiatry
 Pharmacy
Physician Extenders or
Nonphysician Practitioners
 Nurse Practitioners
 Physician Assistants
 Nurse Midwives
 Social W...
Alternative Medicine Providers
 Also known as “complementary medicine”
 Examples include…
 Chiropractic
 Homeopathy, h...
Primary Care Tools
 Clinical guidelines
 Disease management
 Case management
 Pharmacy care management
 Others
Future Trends/Issues
 The aftermath of September 11, 2001
 Mental health needs
 Potential for bioterrorism
Conclusions
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Outpatient Services and Primary Health Care

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Outpatient Services and Primary Health Care

  1. 1. Outpatient Services and Primary Health Care Christy Harris Lemak, Ph.D Associate Professor Health Services Administration
  2. 2. Overview for Today  Outpatient Care  Primary Care  What are key issues?
  3. 3. Some Key Terms  Outpatient Services  Ambulatory Care  Primary Care
  4. 4. Definitions  Outpatient Services = those that do not require overnight hospital stay.  Ambulatory Services = services provided to the “walking” patient.  Community Medicine = services provided in the immediate “community” where patients live
  5. 5. Where is Outpatient Care Provided?  Physician offices  Hospital outpatient departments  Diagnostic (e.g. lab, radiology)  Therapeutic (e.g. PT, chemotherapy)  Hospital emergency departments  Home health agencies  Ambulatory clinics and surgery centers  Chiropractors, other types of providers  Neighborhood health centers  Public health centers/services  Hospice
  6. 6. Outpatient Care = Growth!  All trend lines are up, up, up  Why?  Reimbursement changes  Payments  Utilization controls  New technologies  Patient preferences
  7. 7. Important Considerations  Outpatient services are delivered….  In a variety of settings  By various types of providers  For various conditions  Acute  Chronic  Preventive  Primary, secondary, tertiary  Etc.
  8. 8. Some Trends to Watch  Telephone and Email visits  Group visits  Use of the Internet in various ways  Information (general, specific)  Tracking care (conditions, progress)  Finding providers  Finding support groups, “community”  Increased role of the consumer/patient
  9. 9. The Health Services System  Preventive Care  Primary Care  Secondary Care  Tertiary Care  Restorative Care  Continuing Care
  10. 10. The Health Services System  Preventive Care  Primary Care  Secondary Care  Tertiary Care  Restorative Care  Continuing Care
  11. 11. Understanding Primary Care  Primary Care  Secondary Care  Short-term, sporadic consultation from a specialist for expert opinion or surgical/other intervention  Typically includes hospitalization, surgery, rehabilitation  Tertiary Care  Complex care for conditions that are relatively uncommon (usually institution-based and technology-driven)  Can be long-term  Quaternary Care
  12. 12. Two Dimensions to Consider  Type of Care  Preventive ----- Continuing  Location of Care  Inpatient --- Outpatient  With various inpatient sites (e.g. hospital, nursing home) and outpatient locations (e.g. physician office, surgery center, home)
  13. 13. Primary Care  Three key elements  Point of Entry  Coordination of Care  Essential Care
  14. 14. Point of Entry  First contact with health care system  Gatekeepers  Patients come “through” primary care physicians to hospitals and specialists  Con: Limits care?  Pro: Prevents unnecessary care?
  15. 15. Coordination of Care  PCPs coordinate delivery of care from many sources  Patient advisors, patient advocates  Ensure continuity and comprehensiveness  The Evidence  this works (better health outcomes)  people prefer it (patient satisfaction)
  16. 16. Essential Care  Meeting needs to optimize population health  What is population health?  Why do we care?
  17. 17. Ideal Attributes of Primary Care  Integrated  Coordinating  Continuity of care  Accessibility  Remove barriers of geography, financing, race, language, culture  Accountability  For both patients and providers
  18. 18. Who Provides Primary Care?  Physicians  Doctors  Extenders  Nurses  Ancillary  Alternative
  19. 19. Physicians  PCPs (Primary Care Physicians)  Typically…  Family Practice  General Internal Medicine  Pediatrics  Obstetrics & Gynecology  Others  Controversy  Who?  Specialized primary care training?
  20. 20. PCP Trends  Historically  over-supply of specialists  Bias towards specialists and sub-specialists  Follow the money  Future  Growing demand for PCPs  Income still lower  New organizational and financial structures promoting use of primary care physicians
  21. 21. Doctors  Allopathy  Osteopathy  Optometry  Psychology  Podiatry  Pharmacy
  22. 22. Physician Extenders or Nonphysician Practitioners  Nurse Practitioners  Physician Assistants  Nurse Midwives  Social Workers  Nutritionist
  23. 23. Alternative Medicine Providers  Also known as “complementary medicine”  Examples include…  Chiropractic  Homeopathy, herbal formulas  Acupuncture  Meditation, biofeedback  Spiritual guidance  Others  Trends:  Growth!  Growing acceptance by traditional health care systems
  24. 24. Primary Care Tools  Clinical guidelines  Disease management  Case management  Pharmacy care management  Others
  25. 25. Future Trends/Issues  The aftermath of September 11, 2001  Mental health needs  Potential for bioterrorism
  26. 26. Conclusions

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