Comp2 Unit3a Lecture Slides

The Culture of Healthcare
Healthcare SettingsThe 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.
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)
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Health IT Workforce Curriculum
Version 3.0/Spring 2012
Healthcare SettingsThe Places Where Care is Delivered
Lecture a
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)
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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

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Lecture a
Range of Care Delivery
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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

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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

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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).

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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.

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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

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Lecture a
Ambulatory Services
Non-hospital care, outpatient care
Range of services offered
Primary Care
Doctors office
Clinic
Procedures
Surgery centers
Rehabilitation
Radiology
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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

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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

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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 trendexpected to serve 10% of the
US population under 65 by 2015
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Lecture a
Inpatient Care
Admission for greater than 24 hours
Range of services
Acute care
Chronic care
Mental health care
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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

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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

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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

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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
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Lecture a
Federally Funded Health Care
Institutions
Veterans hospitals
Military Medicine
Indian Health Service
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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
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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

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Lecture a
(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
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Lecture a
(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
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Lecture a
Healthcare SettingsThe 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.
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Lecture a
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
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_op
portunity
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Lecture a
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.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 didnt 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).

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Lecture a

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The Culture of Healthcare

Healthcare SettingsThe Places

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