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

Introduction to Healthcare and
Public Health in the US

Delivering Healthcare (Part 2)
Lecture a
This material (Comp1_Unit3a) 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)
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Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Delivering Healthcare (part 2)
Lecture a
Outpatient Care
Outpatient = not hospitalized
Patient visits an "outpatient facility" for care
Outpatient facilities
Physicians offices
Primary care offices
Specialty care offices
Single specialty or multispecialty offices

3
Lecture a
Other Outpatient Facilities
Dental offices
General dentists or specialists
Medical and diagnostic laboratories
Urgent Care Centers
Mental Health Clinics
Alcohol and Substance Abuse Treatment Center
Outpatient Surgical Centers
Physical and Occupational Therapy Centers
Home Health
Hospice Care
4
Lecture a
What Is Primary Care?
The care provided by certain clinicians
Primary care medical specialties are
family medicine
general internal medicine
general pediatrics
obstetrics and gynecology
Do only physicians provide primary care?
nurse practitioners, physician assistants
5
Lecture a
A level of care or setting
Other levels:
Secondary care
Tertiary care
Primary care is the entry point to a system
Ambulatory versus inpatient care
6
Lecture a
A strategy for organizing the healthcare system
as a whole
Example: community-oriented primary care
Greater emphasis on community-based
healthcare
Lesser emphasis hospital-based, acute-care
medicine

7
Lecture a
The Patient-Clinician Relationship
3.1 Image: Primary Care: America's Health in a New Era-1996.
8
Lecture a
The narrow view
If primary = first in time or order
Then primary care = ground floor of
healthcare delivery
The broad view:
If primary = chief or main
Then primary care = central to healthcare
9
Lecture a
A set of attributes
The 1978 IOM definition:
Care that is
Accessible
Comprehensive
Coordinated
Continuous
Perspectives:
The patient and family
The community
The ecosystem
10
Lecture a
The definition of primary care adopted by the
IOM Committee on the Future of Primary Care:
Primary care is the provision of integrated,
accessible healthcare services by clinicians
who are accountable for addressing a large
majority of personal healthcare needs,
developing a sustained partnership with
patients, and practicing in the context of
family and community.

11
Lecture a
Integrated - provision of services that are:
Comprehensive
Coordinated
Continuous
A seamless process of care combining events
and information that occur in different settings
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Lecture a
Accessible how easy is it for patients to
initiate an interaction for any health problem with
a clinician?
What are the efforts to eliminate barriers to
patient care?
Healthcare services array of services that are
performed by healthcare professionals for the
purpose of promoting, maintaining or restoring
health

13
Lecture a
Clinician means an individual who uses a
recognized scientific knowledge base and has
the authority to direct the delivery of personal
health services to patients.
Patient means an individual who interacts with a
clinician either because of illness or for health
promotion and disease prevention.
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Lecture a
Sustained partnership the relationship
established between the patient and clinician
with the mutual expectation of continuation over
time.
15
Lecture a
Accountable care primary care clinicians and
the systems in which they operate in are
responsible to their patients and communities for
quality of care
patient satisfaction
efficient use of resources
ethical behavior
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Lecture a
Majority of personal healthcare needs
primary care clinicians are trained to diagnose
and manage a large majority of problems that
patients present with
When appropriate, primary care clinicians
may involve specialists

17
Lecture a
Summary Lecture a
Outpatient facilities
Primary care
IOM definition of primary care
Services and barriers involved in primary care
Goals and parties involved in primary care

18
Lecture a
References Lecture a
References
Institute of Medicine. Defining Primary Care: An interim report (1994). National Academy of Press, Washington
DC. Retrieved from http://www.nap.edu/openbook.php?record_id=9153&page=R1
Fry, 1980; Institute of Medicine: Primary Care: America's Health in a New Era, The National Academies Press,
1996.
OTA, (1986); Pew Health Professions Commission, 1994.
IOM. Defining Primary Care: An interim report (1994). National Academy of Press, Washington DC.
http://www.nap.edu/openbook.php?record_id=9153&page=R1
IOM. Primary Care in Medicine: A Definition. In A Manpower Policy for Primary Health Care : Report of a Study.
Washington, D.C. : National Academy Press, 1978. Ch. 2.
IOM: Primary Care: America's Health in a New Era, The National Academies Press, 1996

Images
Slide 8: Image from Institute of Medicine: Primary Care: America's Health in a New Era, The National Academies Press,
1996.

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Lecture a

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

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