Term
| Definition: Amulatory Care |
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Definition
| Ambulatory care is defined as services provided to non-institutionalized patients - including a wide range of services eg routine treatment to surgery. Mobile diagnostic units and home health take services to patients. |
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Term
| Where to go for Ambulatory Care? |
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Definition
1)Office based settings - Solo or group practice
2)Institutional based settings - Hospitals, out pt, specialty clinics, surgery centers, ERs
3)Government Programs - Millitary, VA IHS, CHCs
4) Non-Institutional providers -home health, school, public health service clinics etc (new trend: retail clinics and urgent care centers) |
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Term
| What type of ambulatory care is low discression? |
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Definition
| ER, Urgent Care, (Routine 1st sick visit - middle groud) |
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Term
| What type of ambulatory care is high descression? |
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Definition
| Subsequent (sick visits), Well or preventative care, (routine 1st sick visit -middle groud) |
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Term
| Table 7.1 - What are the new ambulatory care options that were not available previously? |
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Definition
Table 7.1 pg 250 shows the growth in ambulatory options.
Owners and providers -MCOs, insurence companies, corporate companies, group practices
Service settings - community centers, moble imaging services, dialysis centers, fitness/wellness centers, rehab centers, womens health clinics... |
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Term
| What is the scope in outpt services? |
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Definition
-The scop is growing! ewn services, new settings, new types and new ownership.
-Basic services: physical ex, minor treatmenet
-advanced outpatient: in a hospital-base
-hospital inpatient svs on decline
-hospital survival may depend on ambulatory care
---There is competition from home health agencies, ambulatory care, urg care, outpt surg.
-All 1' care is out pt (not all out pt is 1' care - duh) |
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Term
| What are some examples are 1' care service sites? |
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Definition
-phys offices
-hospital emergency services
-1' care center
-Emergent/Urgent care centers
-Ambulatory care sug centers
-community health cenetrs |
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Term
| What is the role of 1' care in ambulatory care? |
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Definition
-It plays a central role in a health care delivery system
-The focus is on the prevention, diagnosis, therapeutic services, health educ, counsling and minor surg |
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Term
| What 3 key elements are a part of the WHO definition of 1' health care? |
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Definition
1) point of entry
2) coordination of care
3) essential care |
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Term
| What is "coordination of care" as it is seen by the WHO definition of 1' care services? |
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Definition
-Delivert of health services between the patient and the different components of the delivery system (pt of reference)
-Refers pts to specialists (triage?)
-gies advice
-Discusses treatment (edu)
-Care for chronic conditions |
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Term
| What % of the population requires 1', 2', and 3' care? |
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Definition
1' care: 75 to 85% of the population
2' care (referral to short term care): 10-12% of the pop
3' care: 5-10% of the pop |
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Term
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Definition
individual.
office based.
It may include different health professionals. |
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Term
| What is a group practice? |
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Definition
affiliation fo 2+ providers.
They all share cost and equiptment, medical records, and support personnel |
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Term
| What is the trend for group practice? |
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Definition
The number of groups is slightly increasing
The number of physician positions in grp practice is dramatically increasing |
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Term
| Tell me some fun facts about outpt care services |
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Definition
1)Outpt exisited before hospitals did.
2)Hospitals are a major player in outpt svs
3) Hospitals capitalized on technilogy to compete
4) solo practices consolidated in response
5) Outpt svs serve the underserved population |
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Term
| Tell me some fun facts about group practice |
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Definition
-Mayo clinic was the first successful grp practice
-ave size ~9 phys
-can be cooperations or partnerships
-IPAs contract agreement
-may be formed by or affiliated with larger organizations |
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Term
| name 5 HOSPITAL BASED outpt svs |
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Definition
1)clinical svs
2)Surg svs
3)Emergency or acute svs (includes urgent svs)
4)Home health care
5)Women's halth |
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Term
| what % of sug are done in ambulatory surg centers? (same day) |
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Definition
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Term
| When was the emergence of freestanding ambulatory surg centers? |
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Definition
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Term
| Who owns, what % of the ambulatory care sug cenetrs? |
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Definition
90% Physicians owned
-increasing number that are medicare certified |
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Term
| What are free standing facilities and provide 3 examples |
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Definition
| Walk in clinics, urgi-centers, surgi-centers |
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Term
| What is the trend of ambulatory care by age and sex? |
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Definition
the very you and the very old report higher use
females report higher use |
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Term
| What is the trend for children with no physician contacts in the last year by poverty status? |
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Definition
-still problems addressing access to health care
-biggest issue for poor and near poor |
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Term
| What are some other outpt svs that are less traditional? |
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Definition
CAM
LT care, home health care, hospice
Moble units
phone access |
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Term
| What are the top 5 reasons to see a ambulatory care visit? |
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Definition
General med exams
progress visit
postoperative visit
cough
pre-natal examination (routine) |
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Term
| Comparing 1995 to 2005, what % office visit, by chronic condition, is higher in 2005? |
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Definition
1) hypertension
2) diabetes
3) depression
(obeasity and copd are a little lower) |
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Term
| What is the 3 largest physician speciality office visit? |
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Definition
General medicine and family medicine
internal medicine
pediatrics |
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Term
| from 1995 and 2005 what is the highest % of duration of visit |
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Definition
11 to 15 mins (increase) highest %
10 to 30 mins (increase) highest %
3 to 10min (decrase)
1 to 6 min (decrease) |
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Term
| What are the trends in ER visits? |
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Definition
10% frewer ERs 2005 than in 1995
219 visits every minute
10% incrase in visits
HIghest are by medicaid or SCHIP
lowest by private ins |
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Term
| What are the trends in ER visits by age? |
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Definition
| highest in 22 to 49 yos, second highest in 66 to 74 yos and increasing in all age groups |
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Term
| By race and age, who most frequents the ER? |
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Definition
Black then hispanic.
The older the more frequent |
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Term
| By urgency who is seen at an ER? |
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Definition
most seen: urgent
2nd most seen: semi-urgent
13.9% non urgent
smallest % immediate + emergent |
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Term
| What are some reasons why outpt svs have grown? |
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Definition
1)Changes in reimbursment - shft to pps that favors outpt svs
2) fewer payment restrictions - paid as ffs
3)Development of new tech - quicker recup
4)utilization controls - managed care restriction on utilization - faster discharges
5) social factors - preference for at home services, nd svs in community based settings |
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Term
| What is the retail clinic? |
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Definition
clinics available at drugstores, grocery, chain stores.
down side: no research on quality of care
Good: able to trim prices by getting rid of extras
Very consumer focused
Fast turn-around
Limited in scope - few services
They may potentially have a short lifeceyle and close shortly after opening if they are not profitable |
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Term
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Definition
The delivery of ambulatory care outside of an ER that you do not need a sheduled appointment for.
May be able to treat 1'care services, but also offer xrays, trauma treatment |
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Term
| Ho many urgent cares are there in the US? |
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Definition
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Term
| How are urgent care centers owned and managed? |
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Definition
(UCCs) can be woned and operated by
hospitals 26%
multi-specialty group practices 8%
independent/private 48%
chains and others ... |
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Term
| What role does UCCs play for occupational halth and meds? |
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Definition
for occupational health - employeer paid services, workers comp
Meds: Point-of-care med dispensing. one stop shop. (may not be the full dose) |
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Term
| What is a potentially preventable hospitalization? |
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Definition
| inpatient stays that might be avoided with the delivery of high quality treatment and disaease management |
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Term
| _ in 10 hospital stays are preventable? |
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Definition
1 in 10
3.9% of acute conditions and 6.2% for chronic conditions |
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Term
| What age group has the most potentially preventable hospital stays? |
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Definition
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Term
| By what income level, are preventable hospital stays more common? |
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Definition
| The poorer have more frequent preventable hospitalizations vs the wealthy |
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Term
| What ins group has the most potentially preventable hospital stays? |
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Definition
| medicare, followed by the uninsured. medicaid and private ins have the lowest |
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Term
| What role does ambulatory svs play in at risk populations? |
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Definition
| the distribution nework is critical to assuring the availability of svs. |
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