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The patient is not hospitalized.
 Typically involves care rendered at an
outpatient facility.
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Provider offices may be single specialty
or multi-specialty.
A specialty is a branch of medicine that
focuses on a particular area of expertise.
 Examples?
 These facilities can be medical or
diagnostic.
 Examples?
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Usually revolves around primary care
 What is primary care?
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› What types of specialties?
› What types of providers?
› What types of facilities?
What is meant by Point of Entry?
 Primary suggests chief or main – central
aspect of healthcare.
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From a patient family perspective
 Accessible
 Comprehensive
 Coordinated
 Continuous
Also includes
 Community
 Integrated delivery systems
 Ecosystem
Comprehensive – address any
healthcare issue throughout the patient’s
life.
 Coordinated – health services and
information meet the needs of the
patient.
 Continuity – long-term clinical
relationship with the patient.
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Geography
 Culture
 Language
 Financial issues
 Administrative hurdles
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A clinician is an individual who has a
recognized scientific knowledge base
and has the authority to direct the
delivery of health services to patients.
 There is an expectation that the
clinician/patient relationship will
continue and aspects of mutual trust,
responsibility, and respect will develop.
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Primary care clinic – gateway to other
healthcare services.
› Family practice
› General internal medicine
› Pediatrics
› Obstetrics/gynecology
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Examples of specialties:
› Dermatology – study of the skin
› Pathology – study of the nature of disease
› Radiology – use of imaging technology to
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diagnose
Nuclear medicine – use of radioactive
substances to diagnose and treat
Psychiatry – study of mental illness
Emergency medicine – care for patients
needing emergency care
Preventative medicine – methods of preventing
illness
Cardiology
 Immunology
 Gastroenterology
 Orthopedics
 Neurology
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These services can be performed in both
outpatient and inpatient facilities.
Increasing number of aging patients.
 Less than ideal preventative care
coverage.
 Increasing levels of documentation.
 Complex billing.
 Medical students don’t consider primary
care ‘attractive’. (The number of US
graduates entering a family practice
residency dropped by 50% between
1997 and 2005.)
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Huge debt upon completing medical
school.
 Specialists are better compensated.
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Challenges of treating older, chronically
ill patients with complex medical issues.
Grants for training and educational
innovation
 Shift in training with emphasis on primary
care
 Increase recruitment of physicians for
primary care (offering incentives)
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Retail clinics – treat common and minor
illnesses. Staffed by nurse practitioners.
› Example Market of Choice – S. Willamette
Urgent care centers – walk-in clinics – more
acute care. Staffed by licensed
practitioners; typically have lab or x-ray
facilities.
 Emergency room – life threatening
emergencies. Overcrowding is a huge issue
fueled by primary care provider shortage.
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Patient-centered homes
› Triage system – nurses can direct patient to
appropriate level of care
› Availability of afterhours care in primary care
clinics, convenience care centers, or urgent
care centers.
› Increasing enrollment in safety net programs.
› Simplification of health information provided
to the patient.
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Laboratories
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Anatomical pathology
Surgical pathology
Chemical pathology
Study of blood
Blood banking
Cytogenetics
Clinical microbiology
Forensic pathology
Molecular pathology

Diagnostic imaging
› X-rays (CT, MRI, PET, ultrasound,
mammography, bone density, and nuclear
medicine)
› Interventional radiology (angiography)
› Teleradiography – review digital images
remotely.
Home health care – domiciliary care or
home care.
 Hospice – terminally ill – life expectancy
not to exceed 6 months
 Physical therapy
 Occupational therapy
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Ancillary care is usually supervised by a
physician.
Provider may be a physician or mid-level
(such as nurse practitioner or physician’s
assistant).
 Point of contact – Front office staff
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› Receptionist
› Greeter
› Triage staff
› Scheduler
Medical office assistant (MOA)
Provider – coordinates the clinical care and
addresses clinical issues.
 Other members of a clinical team
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Care management coordinator
Pharmacist
Dietician
Social worker
Counselor
Back office medical assistants
Coders & billers
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It takes a village …