Introduction to Healthcare and Public Health in the US

1. 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.

2. Delivering Healthcare (Part 2)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) Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 2) Lecture c

3. 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 Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 2) Lecture c

4. 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 Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 2) Lecture c

5. 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 Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 2) Lecture c

6. 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 Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 2) Lecture c

7. 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 Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 2) Lecture c

8. 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 Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 2) Lecture c

9. 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”? Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 2) Lecture c

10. 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 Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 2) Lecture c

11. 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 Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 2) Lecture c

12. Delivering Healthcare (Part 2) Summary – Lecture c • Outpatient care settings • Retail clinics • Urgent care centers • Emergency department, emergency room • Problems and solutions regarding overcrowded emergency rooms Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 2) Lecture c

13. Delivering Healthcare (Part 2) 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 Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 2) Lecture c