Ch 7: Outpatient and Primary Care

what is the accountability domain in primary care?

-Clinicians and patients are accountable. -The clinical system is accountable for providing quality care, producing patient satisfaction, using resources efficiently, and behaving in an ethical manner -Patients are responsible for their own health to the extent of influencing it. -Patients are judicious in the use of resources -There is a partnership between a patient and a clinician where mutual trust, respect, and responsibility are the hallmarks of this partnership.

Extraordinary growth in outpatient services has been attributed to:

-Cost saving measures -New treatment and technologies enabling more care to be provided outside of an inpatient setting -Volume of outpatient services -Emergence of new types of settings -Type and ownership of non-hospital-based facilities offering ambulatory care

From the World Health Organization's (WHO) perspective primary health care means that essential health care is _____

-based on scientific methods -universally accessible and acceptable -affordable at every developmental stage.

Home health refers to service brought into the home such as _____

-nursing care, change dressings, medication monitoring, bathing -Short-term rehabilitation (PT, OT, ST) -Homemaker services (meal prep, shopping, transportation, medical equipment, chores -Durable medical equipment (wheelchairs, oxygen, beds, walkers, commodes) -Alternative would be institutionalization -Maintaining people in the least restrictive environment possible

Primary care practices who have done well in meeting the goals of quality measurement and improvement have done so due to the following four factors: _________

1. A culture committed to using health IT for quality improvement 2. High functioning health IT tools that enable data tracking and mining 3. A clinical team/staff who have the knowledge and skills related to IT, QI 4. Established practice processes and workflow that capture the effectiveness of IT systems in place for QI

free clinics are Modeled after the _______, providing general ambulatory care to the poor

19th-century dispensary

Currently, more than ______ people receive care from CHCs.

25 million

hospice provides services for the terminally ill with a life expectancy of _____

6 months or less

racial/ethnic and insurance coverage disparities are less prevalent in ______ than at primary care providers

CHCs

Which of the following are considered complementary and alternative medicine (CAM) approaches? (select all that apply) Internal medicine Chiropractic medicine Orthopedic medicine Osteopathic medicine

Chiropractic medicine and osteopathic medicine

what are the 5 main types of hospital-based outpatient services?

clinical, surgical, home healthcare, women's health, traditional emergency care

the goal is to bring point of entry as _____ to the population as possible, making it community-based, convenient, and accessible

close

the goals of primary care are best achieved when the patient and provider have established a _______

close relationship over time

________ were created in the 1960s to serve medically underserved regions and offer primary care to anyone seeking care regardless of ability to pay.

community health centers (CHC)

ambulatory care is aka ____

community medicine

Like other outpatient services, ______ agencies may be owned and operated by large corporations or as small mom-and-pop operations. They all must follow applicable state and federal regulations

home health

_______ is a key source of profit for hospitals

hospital-based outpatient services

__________ functions particularly in inner-city areas considered community safety nets, providing primary care to the indigent and uninsured.

hospital-based outpatient services

CHC patients are found to have fewer ______

hospitalizations and office visits

Today, reimbursement for outpatient services tends to be more attractive to providers than providing ______

inpatient care

what is the point of entry domain in primary care?

into the health care system where health care is organized around primary care. First contact a patient makes with the delivery system, uses a gatekeeper who must refer a patient to a specialist or for admission to a hospital.

the Institute of Medicine's (IOM) study On the Future of Primary Care, suggests primary care is _______

is the provision of integrated, accessible health care services by clinicians who address healthcare needs, developing a partnership with patients, the family and community

The ACA created the CHC Fund and provided $11 billion over a 5 year period for the _______

operation, expansion and construction of additional CHCs across the country

______ considered by some to be a form of CAM because of its more holistic approach to care. However, remember despite their somewhat differing approaches, MDs and DOs are both licensed physicians in the United States.

osteopathic medicine

one reason ______ services are important is because of the proportion of health care services that can be attributed to the outpatient setting

outpatient

several factors count for the shift away from solo practice:

p 159

the chronic care model is baed on the premise that ____

p 171

patient-centered medical home accreditation criteria

p 173

primary care practices require 4 interconnected factors to effectively use health IT

p 174

what are the 2 areas of emphasis in hospice?

palliative (pain management), psychosocial and spiritual support

what are the 6 domains of primary care?

point of entry, community based, coordination of care, essential care, integrated, accountability

community-oriented primary care (COPC) incorporates good elements of primary care and adds a _______

population-based approach to identify and address community health problems

most ______ interventions are best carried out in primary care delivery

preventive

________ is the conceptual foundation for outpatient services

primary care

a greater supply of _______ physicians has been associated with lower rates of self-reported poor health, reduced mortality, and increased life expectancy

primary care

In the United States, __________ have created a fragmented system. Primary care does not form the organizing hub for continuous and coordinated health services.

public and private financing

community health centers, free clinics, and other clinics are examples of _____ clinics

public and voluntary

in primary care, what is the clinical system accountable for?

quality of care, patient satisfaction, efficient use of resources, and ethical behavior

Some findings indicate that CHCs have been successful in _______

reducing racial health disparities and in lowering rates of medical utilization by disadvantaged groups

Hospital inpatient services have continued to decline thus outpatient care is seen as essential to the hospitals bottom line (money), making outpatient services NO longer a _______

supplemental service line

_____ are independent of hospitals offering a full range of services that are outpatient and dont require overnight stays

surgi-centers

Many services (diagnostic and therapeutic, including surgical) have shifted from the inpatient setting to the outpatient setting because of ______

technological advancements

the main challenge of community-oriented primary care has been to determine what?

the best means to bring together individual health needs in the larger context of community health needs

why is chiropractic care defined as a form of CAM?

the discipline may recommend therapeutic and rehabilitative exercises and nutritional, dietary and lifestyle counseling.

home healthcare is consistent with the philosophy of maintaining people in _______

the least restrictive environment possible

free-standing facilities include _____

walk-in clinics, ambulatory care from basic primary to urgent care, surgi-centers

Ambulatory care constitutes diagnostic and therapeutic services and treatments provided to the "_____" (ambulatory) patient

walking

what is accessibility?

ase with which a patient can initiate an interaction with a clinician for any health problem.

triage nurses have _____

-Access to patient records -Guidance using protocols -Consultations with physicians

what is the integrated domain in primary care?

-Care is comprehensive -it addresses health problems at any stage of a patient's life cycle, it is coordinated, and combines health services to best meet the patient's needs -It is continuous services with care provided over time by a single provider or a team of health care professionals that provide a seamless process of care

the main types of hospital-based outpatient services include _____

-Clinical (typically for uninsured or research) -Surgical (same day surgery), -Home health (post-acute care and rehabilitation), -Women's health, and -Traditional emergency

patient's expect healthcare services to create minimal disruptions and prefer to recuperate at home due to what factors?

-More comfortable, independence and control -Potentially better recuperation -Avoidance of nosocomial (hospital-acquired) infections

what are the three characteristics of free clinics?

-Services provided at no or a nominal charge. -Not directly supported or operated by the government or the health department. -services delivered by trained volunteers

solo (private) practices are merging into groups or with hospital system due to what factors?

-Uncertainties of the health care delivery system, -Competition from large health organizations, -High cost of establishing a new practice, -Complexity of billings and collections -Increased external controls over private practice.

CHCs have made major advances in ______

-adopting evidence base practices -improving patient safety -meeting national accreditation standards, including the medical home model -increasing the coordination, integration, and management of health center care

what are the elements of community-oriented primary care (COPC)?

-central delivery of primary care -includes biopsychosocial elements of care in addition to medicine -emphasizes primary and secondary prevention must be linked -public health must have clinical interventions in conjunction with schools, social service agencies, churches, and employers, to strengthen public health programs.

continuum of care encompasses at least seven categories of multiple services that an individual may need overtime including ______

-extended Care - Long term care, skilled nursing facilities -Acute - Inpatient services of all types -Ambulatory/Outpatient - Physician offices, outpatient clinics, behavioral services -Outreach and Linkage - Screening, transportation, senior programs -Wellness and Health Promotion - Disease management, exercise programs -Housing - Retirement communities, assisted living

what is ambulatory care?

Also referred to as outpatient services. Ambulatory care includes (1) care rendered to patients who come to physicians' offices, outpatient departments of hospitals, and health centers to receive care; (2) outpatient services intended to serve the surrounding community (community medicine); and (3) certain services that are transported to the patient.

the _______ recommended he medical home care model as a fundamental change in the provision and financing of primary care

American college of physicians (ACP)

community health centers operate under what?

Bureau of Primary Health Care, U.S. Public Health Service, U.S. Department of Health and Human Services

It is estimated that if ______ stops funding CHCs approximately 1,400 centers will have to close, 50,000 providers and staff would be laid off and 9 million patients will lose healthcare.

Congress

much complementary and alternative medicine (CAM) has roots in and alignments with ______

Eastern medicine and its values

what is integrated care?

Embodies concepts of comprehensive, coordinated, and continuous services that provide a seamless process of care

what is primary healthcare?

Foundation of ambulatory services, characterized by first level of contact between individuals, family and community and health care delivery system, bringing health care as close as possible to where people live and work

what is telephone triage?

Giving expert opinion and advice to the patient, especially during hours when a physician's office is usually closed

what is the essential care domain in primary care?

Goal is to optimize population health and minimize disparities to ensure equal access

The use of ______ was also a component of the ACA and its goal of quality improvement in health care delivery. Data tracking and reporting on quality measures, e-prescribing, implementation of decision support and participation in health information exchanges (HIE) were some of the criteria for providers and facilities to qualify for these financial incentives.

Health IT

what is integrative medicine?

Health care approaches that use mainstream medicine along with complementary and/or alternative approaches.

_____ refers to care given that does not require an overnight inpatient stay. It is a more comprehensive term than ambulatory since it literally encompasses dozens of different types of outpatient care services.

Outpatient

_______ services can be offered by both hospitals and community organizations.

Outpatient

________ have become a mainstay in the delivery of health care in the U.S., with primary care as the main entry point to the health care system.

Outpatient services and ambulatory care

CAM includes the following types of services;

Massage therapy Herbal remedies Vitamin therapy Meditation Cupping Acupuncture Acupressure Homeopathy Yoga Prayer Reflexology Examples of CAM Bee venom injections Magnetic field therapy Aromatherapy Astrology Auricular therapy Biofeedback Nutrition Hypnosis Hydrotherapy Kinesiology chiropractice care

what is a medical home?

Patient-centered care based on the principles of the Chronic Care Model; use evidence-based guidelines; apply appropriate health information technology; and demonstrate the use of 'best practices' to consistently and reliably meet the needs of patients while being accountable for the quality and value of care provided.

What is the key difference between primary care and specialty care?

Primary care focuses on patients as persons and specialty care focuses on patients and their specific diseases.

what is considered secondary care?

Routine hospitalization, routine surgery, and specialized outpatient care, such as consultation with specialists and rehabilitation. Compared to primary care, these services are usually brief and more complex, involving advanced diagnostic and therapeutic procedures

Growth of outpatient services have occurred due to all of the following EXCEPT: Changes in patient expectations Shortage of inpatient beds Reimbursement more attractive than inpatient options Improved technology

Shortage of inpatient beds

Which of the following factors contributes to the growing trend toward outpatient care? Social Utilization Technology Reimbursement

Social Utilization Technology Reimbursement

T/F: The National Committee for Quality Assurance's (NCQA) Patient Centered Medical Home Recognition Program is the most widely adopted patient-centered medical home model (PCMH) evaluation program in the U.S.

T

what is gatekeeping?

The use of primary care physicians (gatekeeper) to coordinate health care services needed by an enrollee in a managed care plan.

alternative medicine _____

Uses a non-mainstream approach in place of conventional medicine

complimentary medicine ____

Uses a non-mainstream approach together with conventional medicine

Office-based physicians form the backbone of _____ care providing the vast majority of primary care services

ambulatory

The 2009 HITECH (Health Information Technology for Economic and Clinical Health) changed the landscape of primary care practice when it provided _______

a financial incentive to providers who were willing to invest in and comply with meaningful use criteria of EHRs

The term "outpatient" can be used interchangeably with which term?

ambulatory

To survive, hospitals depend heavily on outpatient services with an emphasis on _______ because of competition from other outpatient services.

ambulatory care

Community health centers (CHC) are required by law to be located in medically underserved areas and to provide services to ______

anyone seeking care, regardless of insurance status or ability to pay

primary care is an _______ to providing health care. It encompasses both primary and secondary prevention

approach

If the outpatient provider chooses to be ______ by an organization like The Joint Commission, the accrediting body's requirements must also be met.

accredited

both _________ and ________ of interventions are better when primary care physicians refer patients to specialists, rather than when patients engage in self-referral

appropriates and the outcomes

Countries oriented toward primary care achieve _______

better health levels, higher satisfaction services, and lower expenditures in delivery of health

workforce shortages and a lack of financial incentives to provide care beyond individual health needs have been two major obstacles to adopting the _______

biopsychosocial paradigm

what is the community based domain in primary care?

care should be available in close proximity to where people reside and near where they work, making care convenient and accessible

what are the two types of ambulatory long-term care services?

case management, adult day care

Primary care practices have also enhanced their ability to manage patients who have chronic conditions by using the following Health IT applications: _____

clinical decision support (CDS), disease registries, EHRs with integrated chronic care management tools and CDS systems, health information exchanges, patient portals, Telehealth applications

Nontraditional therapies are also called _______

complementary and alternative medicine (CAM)

Continuum of care has been defined as _____

concept involving an integrated system of care that guides and tracks a patient over time through a comprehensive array of health services spanning all levels of intensity of care

the main advantages of walk-in clinics and urgent care enters are ______

convenience of location, evening and weekend hours, availability of services without appointment

what is the coordination of care domain in primary care?

coordinate delivery of health services between patient and myriad of system components. Refers patients to sources of specialized care, gives advice regarding various diagnosis and therapies, ensures continuity and comprehensiveness of care, discusses treatment options, and provides continuing care of chronic conditions.

ambulatory long-term care services involve case management via _________

coordination and referral to locate the most appropriate care

historically, outpatient services have played a role in the survival of many health care organizations. the prospective payment system (PPS) was created for the acute inpatient setting, which forced hospitals to look at other care settings (including outpatient) to offset _______

declining inpatient revenue

Primary care systems around the world have seen an ______ in their medical workforce.

decrease

primary care is regarded as ____ healthcare

essential

private practice Visits are short in duration with limited _______

examination and testing

one part of utilization's contribution to the inpatient to outpatient shift is that Payers also use fewer resources when they do not have to perform as many ______ of inpatient services.

extensive reviews

______ is the main reason that dental and optometric services are not integrated with other outpatient medical services: medical, dental, and vision are traditionally separate insurance plans

financing

if an outpatient service facility plans on billing medicare and medicaid what must they do?

follow the certification requirements for Medicare and Medicaid providers

the _______ of ambulatory services is intended for the purpose of serving the surrounding community, providing convenience and easy accessibility.

geographic location

Outpatient services are a win-win for payers and providers because they cost ____ with the percentage of reimbursement often exceeding the cost of providing the service

less

public health service is typically provided by ________ and includes:

local health departments -Well-baby care, -Venereal disease clinics, -Family planning services, -Screening and treatment for tuberculosis, -Ambulatory mental health

areas with higher primary care physician-to-population ratios experience _____ total healthcare costs

lower

evidence shows that _________ are strongly associated with receiving primary care

lower hospitalization rates for ambulatory care conditions

what are mobile diagnostic care units?

mammography, MRI

hospice services include _____

medical, psychological, and social services, provided in a holistic context and access to supplies

community health centers were authorized in the 1960s to serve the ________

medically underserved

hospice is a ______ of care, not a location, and addresses the special needs of _______

method, dying person and their family

most physician office visits (93%) took place in ____ areas

metropolitan

what are other health centers supported by federal funding aside from CHCs?

migrant health centers, rural health centers

Complementary health approaches Include ________

natural products (such as herbs, vitamins, minerals, probiotics sold as dietary supplements) and mind and body practices such as acupuncture, massage, meditation, relaxation, etc

social factors have influenced the shift from inpatient to outpatient because outpatient services become the ______ for providers and payers, they also become the expectation of patients

norm

what 4 key changes have contributed to the shift from inpatient to outpatient services?

reimbursement, technology, utilization control, social factors

one part of utilization's contribution to the inpatient to outpatient shift is that Payers prefer outpatient services because the provider uses fewer _______ which drives down the cost

resources

many hospital outpatient clinics, particularly those in inner-city areas, function as the community's _____

safety net

generally, public health programs are limited in ____

scope

Outpatient services cost less, due in part to _________ (this is attractive to payers).

shortened stays and elimination of room and board costs

one way technology is contributing to the shift from inpatient to outpatient settings is that Anesthetics have been developed that act more quickly and with a _______

shorter effect time

mobile healthcare services mainly benefit populations in ______

small towns, rural communities, and nursing homes

in primary care, what is the patient accountable for?

their own health and use of resources

what are mobile health units?

transported to patients such as ambulances with EMTs

one way technology is contributing to the shift from inpatient to outpatient settings is that Minimally invasive procedures are less _____, allowing them to be rendered on an outpatient basis.

traumatic

gatekeepers protect patients from _________

unnecessary procedures and over-treatment

gatekeeping in primary care usually protects patients from _______

unnecessary procedures and overtreatment

________ accept patients without appointments on first come first served basis

urgent care centers