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Delivering Healthcare
Outpatient CareAncillary CareProvider Roles
Outpatient Care
The patient is not hospitalized.Typically involves care rendered at an outpatient facility.Provider offices may be single specialty or multi-specialty.
Whatis multi-speciality?
A specialty is abranch of medicine that focuses on a particular area of expertise.Examples?These facilities can be medical or diagnostic.Examples?
Outpatient care
Usually revolves around primary careWhat is primary care?What types of specialties?What types of providers?What types of facilities?What is meant by Point of Entry?Primary suggests chief or main – central aspect of healthcare.
Primary care attributes
From a patient family perspectiveAccessibleComprehensiveCoordinatedContinuousAlso includesCommunityIntegrated delivery systemsEcosystem
Integrated care
Comprehensive – address any healthcare issue throughout the patient’s life.Coordinated – health services and information meet the needs of the patient.Continuity – long-term clinical relationship with the patient.
Barriers to access?
GeographyCultureLanguageFinancial issuesAdministrative hurdles
Who is the clinician?
A clinician is an individual who has a recognized scientific knowledge base and has the authority to direct the delivery of health services to patients.There is an expectationthat the clinician/patient relationship will continue andaspectsof mutual trust, responsibility, andrespect will develop.
Where are services delivered?
Primary care clinic – gateway to other healthcare services.Family practiceGeneral internal medicinePediatricsObstetrics/gynecology
Specialty care
Examples of specialties:Dermatology – study of the skinPathology – study of the nature of diseaseRadiology – use of imaging technology to diagnoseNuclear medicine – use of radioactive substances to diagnose and treatPsychiatry – study of mental illnessEmergency medicine – care for patients needing emergency carePreventative medicine – methods of preventing illness
Medical & Surgical Specialties
CardiologyImmunologyGastroenterologyOrthopedicsNeurologyThese services can be performed in both outpatient and inpatient facilities.
Primary care in crisis?
Increasing number of aging patients.Less than ideal preventative care coverage.Increasing levels of documentation.Complex billing.Medical students don’t consider primary care ‘attractive’. (The number of US graduates entering afamily practice residencydropped by 50% between 1997 and 2005.)
Huge debt upon completing medical school.Specialists are better compensated.Challenges of treating older, chronically ill patients with complex medical issues.
How do we fix this?
Grants for training and educational innovationShift in training with emphasis on primary careIncrease recruitment of physicians for primary care (offering incentives)
Outpatient care
Retail clinics – treat common and minor illnesses. Staffed by nursepractitioners.Example Market of Choice – S. WillametteUrgent care centers – walk-in clinics – more acute care. Staffed by licensed practitioners; typically have lab or x-ray facilities.Emergency room – life threatening emergencies. Overcrowding is a huge issue fueled by primary care provider shortage.
Solution: Patient education
Patient-centered homesTriage system – nurses can direct patient to appropriate level of careAvailability of afterhours care in primary care clinics, convenience care centers, or urgent care centers.Increasing enrollment in safety net programs.Simplification of health information provided to the patient.
Ancillary services
LaboratoriesAnatomical pathologySurgical pathologyChemical pathologyStudy of bloodBlood bankingCytogeneticsClinical microbiologyForensic pathologyMolecular pathology
Ancillary services
Diagnostic imagingX-rays (CT, MRI, PET, ultrasound, mammography, bone density, and nuclear medicine)Interventional radiology (angiography)Teleradiography– review digital images remotely.
Ancillary services
Home health care – domiciliary care or home care.Hospice – terminally ill – life expectancy not to exceed 6 monthsPhysical therapyOccupational therapyAncillary care is usually supervised by a physician.
Provider & Patient
Provider may be a physician or mid-level (such as nurse practitioner or physician’s assistant).Point of contact – Front office staffReceptionistGreeterTriage staffScheduler
Medical office assistant (MOA)Provider – coordinates the clinical care and addresses clinical issues.Other members of a clinical teamCare management coordinatorPharmacistDieticianSocial workerCounselorBack office medical assistantsCoders & billers
Healthcare Delivery
It takesa village …





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Delivering Healthcare -