1. The Culture of Healthcare Healthcare Settings–The Places Where Care is Delivered Lecture a This material (Comp2_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. Healthcare Settings– The Places Where Care is Delivered Learning Objectives Differentiate the range of care delivery organizations, including primary care, specialty care, tertiary care, inpatient and outpatient facilities, long-term care hospitals, and long-term care facilities (Lecture a) Analyze the organization of healthcare delivery from the perspective of a “continuum of care,” such as ambulatory services, in-patient care, long-term care, and end-of-life care (Lecture a) Evaluate the similarities and differences of community hospitals, teaching hospitals, and community health clinics (Lecture a) 2 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Healthcare Settings—The Places Where Care is Delivered Lecture a

3. Healthcare Settings– The Places Where Care is Delivered Learning Objectives (continued) Describe the various departments and services offered by an outpatient clinic, community hospital, academic medical center, and long-term care facility (Lecture b) Explain the ways in which these departments interact and the services relate (Lecture b) Speculate on the data and information that are created and used by people in these departments (Lecture b) Describe ways in which medical and/or information technology has improved interdepartmental communication and how that has improved the patient experience (Lecture b) 3 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Healthcare Settings—The Places Where Care is Delivered Lecture a

4. The Range of Health Care Organizations Range of health core organizations in terms of level of care The “Continuum of Care” Unique functions and interrelationships between health care organizations 4 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Healthcare Settings—The Places Where Care is Delivered Lecture a

5. Range of Care Delivery 5 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Healthcare Settings—The Places Where Care is Delivered Lecture a 3.1 Figure: Represents the range of care delivery and the referral patterns between the types of care of delivery organizations. (Hickman 2012, CC BY-NC-SA 3.0)

6. Primary Care Organization “Primary care is the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community.” (Donaldson et all.ed., 1996). Main function is to provide screening, prevention, diagnosis, and treatment for acute and chronic health problems 6 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Healthcare Settings—The Places Where Care is Delivered Lecture a

7. Secondary Care Organization Also referred to as specialty care organizations Provides majority of types of specialty diagnoses and treatment Includes free-standing ambulatory facilities, community hospitals, and academic medical centers 7 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Healthcare Settings—The Places Where Care is Delivered Lecture a

8. Tertiary Care Center “A tertiary care center is a medical facility that receives referrals from both primary and secondary care levels and usually offers tests, treatments, and procedures that are not available elsewhere. Most tertiary care centers offer a mixture of primary, secondary, and tertiary care services so that it is the specific level of service rendered rather than the facility that determines the designation of care in a given study.” (JAMA, 2011). 8 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Healthcare Settings—The Places Where Care is Delivered Lecture a

9. Integrated Health Care Delivery Provide a full range of care Informal association between practitioners, ambulatory facilities, hospitals, and academic medical center Formal organizations that provide facilities under a single management structure to manage primary, secondary and tertiary care services. 9 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Healthcare Settings—The Places Where Care is Delivered Lecture a

10. The “Continuum of Care” Definition –Entry –Care no longer needed Birth to death Diagnosis until “return to usual function” Organizations are often designed to provide services in a specific phase of this continuum 10 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Healthcare Settings—The Places Where Care is Delivered Lecture a

11. Ambulatory Services Non-hospital care, outpatient care Range of services offered –Primary Care Doctor’s office Clinic –Procedures Surgery centers Rehabilitation Radiology 11 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Healthcare Settings—The Places Where Care is Delivered Lecture a

12. Community Health Clinic “Health centers are community-based and patient-directed organizations that serve populations with limited access to health care.” (HRSA., 2011). Types –Grant-Supported Federally Qualified Health Centers –Look-alikes –Tribal-operated –Others 12 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Healthcare Settings—The Places Where Care is Delivered Lecture a

13. School-Based Health Centers (NASBHC., 2011). Located in schools Range of services –Screening, preventive, and acute care –Behavioral care –Counseling Linkage with other medical providers 13 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Healthcare Settings—The Places Where Care is Delivered Lecture a

14. Employer-Based Health Clinics (Healthcare Strategy Group, 2011). Primary and urgent care Occupational health, preventive and wellness, chronic disease management Aimed at containing health care costs –Employer retains utilization decisions –Shifts emphasis from illness care to preventive care Growing trend—expected to serve 10% of the US population under 65 by 2015 14 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Healthcare Settings—The Places Where Care is Delivered Lecture a

15. Inpatient Care Admission for greater than 24 hours Range of services –Acute care –Chronic care –Mental health care 15 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Healthcare Settings—The Places Where Care is Delivered Lecture a

16. Types of Hospitals (AHA., 2011). Community Hospitals –“Community hospitals are defined as all nonfederal, short-term general, and other special hospitals” Teaching Hospital (Academic Hospital) –Usually associated with a university or medical school –Major role in clinical training of health professionals 16 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Healthcare Settings—The Places Where Care is Delivered Lecture a

17. Long-Term Care (HHS., 2011). Adult Day Care –Meals and activities limited during the day Independent Living –Retirement community –Per-service options Assisted Living –Apartment or room –Personal care, medication, meals, housekeeping 17 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Healthcare Settings—The Places Where Care is Delivered Lecture a

18. Long-Term Care Skilled Nursing Facilities (HHS, 2011). –Full medical care –Assistance with activities of daily living –Meals Long-Term Care Hospitals (CMS, 2011). –Acute care hospitals –Average stay greater than 25 days –Expect patients to return home 18 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Healthcare Settings—The Places Where Care is Delivered Lecture a

19. End-of-Life Care Hospice –“A hospice is a comprehensive service provided to people living with and dying from an eventually fatal condition” (Palliative Care, Australia, 2011). Home Day Facility 19 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Healthcare Settings—The Places Where Care is Delivered Lecture a

20. Federally Funded Health Care Institutions Veterans hospitals Military Medicine Indian Health Service 20 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Healthcare Settings—The Places Where Care is Delivered Lecture a

21. Veterans Health Administration “The Veterans Health Administration is home to the United States’ largest integrated health care system consisting of 152 medical centers, nearly 1,400 community-based outpatient clinics, community living centers, Vet Centers, and Domiciliaries” (Department of Veterans Affairs, 2011) –Primary Care –Specialty Care –Tertiary Care 21 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Healthcare Settings—The Places Where Care is Delivered Lecture a

22. Military Medicine (The Military Health System, 2011). Part of the US Department of Defense Military Health System –Ensure delivery of world-class health care –Facilities for each branch TRICARE partnership network ensures accessibility of care –Military facilities –Supplemented by private-sector services 22 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Healthcare Settings—The Places Where Care is Delivered Lecture a

23. Indian Health Service (Indian Health Service, 2011). Agency within the US. Department of Health and Human Services –Provides health services for American Indians and Alaska Natives –Goals are to ensure access to health services and reduce health disparities 23 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Healthcare Settings—The Places Where Care is Delivered Lecture a

24. Indian Health Service (Indian Health Service, 2011). Federal IHS system includes 28 hospitals, 63 health centers, 31 health stations, and 34 urban projects American Indian tribes and Alaska Native corporations independently administer 17 additional hospitals, 263 health centers, 92 health stations, and 166 Alaska village clinics Additional services are contracted through private providers 24 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Healthcare Settings—The Places Where Care is Delivered Lecture a

25. Healthcare Settings—The Places Where Care is Delivered Summary – Lecture a Discussed the range of health care organizations: primary care, secondary care, and tertiary care Defined organizations by type of services that they provide in the “Continuum of Care”: the care a patient receives from entry into the system until care is no longer needed. Described some of the unique health care organizations and relationships between organizations. 25 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Healthcare Settings—The Places Where Care is Delivered Lecture a

26. Healthcare Settings—The Places Where Healthcare is Delivered References – Lecture a References American Hospital Associate. (2011.) Fast facts on US hospitals. Retrieved from http://www.aha.org/research/rc/stat-studies/fast-facts.shtml http://www.aha.org/research/rc/stat-studies/fast-facts.shtml Centers for Medicare and Medicaid Services. (2011). What are long-term care hospitals? Retrieved from http://www.medicare.gov/publications/pubs/pdf/11347.pdf http://www.medicare.gov/publications/pubs/pdf/11347.pdf Department of Health and Human Services, National Clearing House for Long Term Care Information. (2011). Services and providers. Retrieved from http://www.longtermcare.gov/LTC/Main_Site/Understanding/Services/Index.aspx http://www.longtermcare.gov/LTC/Main_Site/Understanding/Services/Index.aspx Department of Veterans Affairs. (2011) About the VHA (Veterans Health Administration). Retrieved from http://www.va.gov/health/aboutVHA.asp Donaldson MS, Yordy KD, Lohr KN, Vanselow, Eds; Committee on the Future of Primary Care, Institute of Medicine. (1996). Primary care: Americas health in a new era. Washington, DC: National Academy Press. p. 31- 32. Retrieved from: http://www.nap.edu/catalog.php?record_id=5152.http://www.nap.edu/catalog.php?record_id=5152 Healthcare Strategy Group. Employer health clinics-threat and opportunity. Retrieved from http://www.healthcarestrategygroup.com/newsletters/article.php?show=employer_health_clinics___threat_and_op portunity http://www.healthcarestrategygroup.com/newsletters/article.php?show=employer_health_clinics___threat_and_op portunity 26 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Healthcare Settings—The Places Where Care is Delivered Lecture a

27. Healthcare Settings—The Places Where Healthcare is Delivered References – Lecture a References Health Resources and Health Administration, Bureau of Health Professions. (2011). What is a health center? Retrieved from http://bphc.hrsa.gov/about/index.htmlhttp://bphc.hrsa.gov/about/index.html Indian Health Services, Department of Health and Human Services. (2001). Indian Health Service: A quick look retrieved from http://www.ihs.gov/PublicAffairs/IHSBrochure/QuickLook2011.asp. Journal of the American Medical Association.(2011). Glossary of methodologic terms. Retrieved from http://jama.ama-assn.org/site/misc/auinst_term.xhtml#tertiary http://jama.ama-assn.org/site/misc/auinst_term.xhtml#tertiary Kane RL. (2011). Finding the right level of posthospital care: “We didn’t’ realize there was any other option”. The Journal of the American Medical Association, 305(3), 284-293. Military Health System, US Department of Defense. About MHS. Retrieved from http://www.health.mil/About_MHS/Organizations/Index.aspx National Assembly on School-Based Health Care. (2011) About school-based health. Retrieved from http://www.nasbhc.org/site/c.ckLQKbOVLkK6E/b.7528935/k.84EA/About_SBHCs.htm Palliative Care Australia. 2008. Palliative and End of Life Care: Glossary of terms. Retrieved from http://www.palliativecare.org.au/Portals/46/docs/publications/PCA%20Glossary.pdf http://www.palliativecare.org.au/Portals/46/docs/publications/PCA%20Glossary.pdf Charts, Tables; Figures 3.1 Figure: Hickman (2012). Represents the range of care delivery and the referral patterns between the types of care of delivery organizations. (CC BY-NC-SA 3.0). 27 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Healthcare Settings—The Places Where Care is Delivered Lecture a