Introduction to Healthcare and Public Health in the US

1. 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.

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 a

3. Outpatient Care • Outpatient = not hospitalized • Patient visits an "outpatient facility" for care • Outpatient facilities • Physician’s offices • Primary care offices • Specialty care offices • Single specialty or multispecialty offices Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 2) Lecture a

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

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

6. What Is Primary Care? • 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 Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 2) Lecture a

7. What Is Primary Care? • 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 Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 2) Lecture a

8. The Patient-Clinician Relationship 3.1 Image: Primary Care: America's Health in a New Era-1996. Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 2) Lecture a

9. What Is Primary Care? • 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 Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 2) Lecture a

10. What Is Primary Care? • A set of attributes • The 1978 IOM definition: • Care that is • Accessible • Comprehensive • Coordinated • Continuous • Perspectives: • The patient and family • The community • The ecosystem Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 2) Lecture a

11. What Is Primary Care? • 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. Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 2) Lecture a

12. What Is Primary Care? • Integrated - provision of services that are: • Comprehensive • Coordinated • Continuous • A seamless process of care combining events and information that occur in different settings Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 2) Lecture a

13. What Is Primary Care? • 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 Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 2) Lecture a

14. What Is Primary Care? • 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. Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 2) Lecture a

15. What Is Primary Care? • Sustained partnership – the relationship established between the patient and clinician with the mutual expectation of continuation over time. Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 2) Lecture a

16. What Is Primary Care? • 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 Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 2) Lecture a

17. What Is Primary Care? • 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 Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 2) Lecture a

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

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