2.5 Chapter Summary

Healthcare providers and administrators need to view care delivery as occurring along a continuum with distinct phases marked by changing levels of intensity of care. Delivery systems include inpatient, outpatient, post-acute, long-term, palliative, and hospice care. Inpatient services are services that involve an overnight stay or prolong the stay of a patient in a licensed healthcare facility. Historically, in the United States (U.S.), inpatient services are provided by hospitals. Hospitals are the most common healthcare facility for inpatient services. Hospitals may be classified by type of service, ownership, size (in terms of the number of beds), and length of stay. Community hospitals form the bulk of hospitals and hospital beds in the U.S. The AHA categorizes community hospitals by ownership, number of beds, and whether it is a teaching, critical access, or specialty hospital. Emergency departments are a major part of the US healthcare safety-net (Mortensen, 2014; Rhodes et al., 2013). Emergency departments in hospitals provide care to anyone needing emergency treatment, but tend to be overused for non-urgent and serious problems that could have been prevented with better primary and specialty care.

Outpatient services occur in a facility or setting where there is no need for an overnight stay. Primary care is the entry point into the healthcare system and is one of the most utilized outpatient services. The four pillars of primary care include a patient’s first contact with the healthcare system, continuity of care over time, comprehensiveness, and coordination of care. Venues for the delivery of primary care are private physician clinics, public or non-profit community health centers, outpatient clinics in hospitals, workplace wellness programs, and retail clinics. Two models of care are being employed to increase efficiencies in primary care delivery include patient-centered medical homes and accountable care organizations. An ambulatory surgical center is a outpatient facility that operates primarily to provide surgical services to patients who do not require overnight hospital care. Compared to hospital-based surgical centers, ambulatory surgical centers are perceived to be more conveniently located and to have better scheduling for both physician and patient, greater physician and patient satisfaction, similar quality, and lower costs. Lastly, urgent care is provided outside the emergency department setting in urgent care centers that provide care on a walk-in basis, have extended hours into the evening Monday to Friday and at least one day over the weekend, and have on-site laboratories and radiology.

Recognition of how PAC fits within the continuum can help to ensure patients achieve the greatest value possible from those delivering their care. PAC serves as a bridge to help patients regain the functional capabilities they need to return to as normal a life as possible following an illness, accident, or injury. Long-term care is another continuum of institutional and community-based services. This broad range of personal, social, and medical services is provided in many locations, including private homes, adult day-care settings, residential care/assisted living facilities, and nursing homes. Lastly, while the objective of both hospice and palliative care is pain and symptom relief, the prognosis and care goals tend to differ. Hospice is comfort care without curative intent; the patient no longer has curative options or has chosen not to pursue treatment because the side effects outweigh the benefits. Palliative care is comfort care with or without curative intent.

Key terms included in this chapter are also listed in the Glossary at the end of the book.

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