Comp2 Unit3a Lecture Slides

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.


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)

2Health IT Workforce Curriculum Version 3.0/Spring 2012

The Culture of Healthcare Healthcare Settings—The Places Where Care is Delivered

Lecture a


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)



Lecture a

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



Lecture a

Range of Care Delivery



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)

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



Lecture a

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



Lecture a

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).



Lecture a

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.



Lecture a

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



Lecture a

Ambulatory Services• Non-hospital care, outpatient care• Range of services offered

– Primary Care• Doctor’s office• Clinic

– Procedures• Surgery centers• Rehabilitation• Radiology



Lecture a

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



Lecture a

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



Lecture a

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



Lecture a

Inpatient Care• Admission for greater than 24 hours• Range of services

– Acute care– Chronic care– Mental health care



Lecture a

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



Lecture a

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



Lecture a

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



Lecture a

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



Lecture a

Federally Funded Health Care Institutions

• Veterans hospitals• Military Medicine• Indian Health Service



Lecture a

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



Lecture a

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



Lecture a

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



Lecture a

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



Lecture a

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.



Lecture a

Healthcare Settings—The Places Where Healthcare is Delivered

References – Lecture aReferences• American Hospital Associate. (2011.) Fast facts on US hospitals. Retrieved from

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 • 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

• 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.

• Healthcare Strategy Group. Employer health clinics-threat and opportunity. Retrieved from http://www.healthcarestrategygroup.com/newsletters/article.php?show=employer_health_clinics___threat_and_opportunity



Lecture a

Healthcare Settings—The Places Where Healthcare is Delivered

References – Lecture aReferences• Health Resources and Health Administration, Bureau of Health Professions. (2011). What is a health center?

Retrieved from http://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• 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

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).



Lecture a

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Comp2 Unit3a Lecture Slides

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