1. Component 1: Introduction to Health Care and Public Health in the U.S. Unit 3: Delivering Healthcare (Part 2) Lecture 3 This material was developed by Oregon Health & 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. 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 Component 1 / Unit 3-3 Health IT Workforce Curriculum Version 2.0/Spring 2011 2

3. 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 Component 1 / Unit 3-3 Health IT Workforce Curriculum Version 2.0/Spring 2011 3

4. Outpatient Care: Urgent Care Centers Typically have laboratory and/or X-ray facilities on-site Some may have more advanced diagnostic equipment Not intended to treat life-threatening emergencies Component 1 / Unit 3-3 Health IT Workforce Curriculum Version 2.0/Spring 2011 4

5. Outpatient Care: Emergency Department 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 ED visit rate was infants under 12 months of age 12.8% (15.3 million visits) resulted in admission to the hospital in 2006 Component 1 / Unit 3-3 Health IT Workforce Curriculum Version 2.0/Spring 2011 5

6. Outpatient Care: Emergency Department 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 Component 1 / Unit 3-3 Health IT Workforce Curriculum Version 2.0/Spring 2011 6

7. 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 Component 1 / Unit 3-3 Health IT Workforce Curriculum Version 2.0/Spring 2011 7

8. 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”? Component 1 / Unit 3-3 Health IT Workforce Curriculum Version 2.0/Spring 2011 8

9. 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 Component 1 / Unit 3-3 Health IT Workforce Curriculum Version 2.0/Spring 2011 9

10. 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 Component 1 / Unit 3-3 Health IT Workforce Curriculum Version 2.0/Spring 2011 10