Chapter 7: Outpatient Services and Primary Care

Applied Science

Essentials of the U.S. Health Care System, Fifth Edition

Leiyu Shi and Douglas Singh

Case Study

Chapter 7: Outpatient Services and Primary Care

Good clinical decision-making is only as good as the quality and integrity of the documented patient health information. Integrating clinical best practices, long-term care, and strategic planning promote continuity of care across the entire health system (Smith, 2015). For example, the adoption of a robust health information system such as a clinical decision support system (CDSS) can help to establish tight controls and ensure that patient diagnoses, interventions, and treatments are valid, accurate, and based on reliable data.

Case Report

Avera Health Plans was founded in 1999 and has since become one of South Dakota’s leading health insurers. In July 2018, Avera launched a systemwide initiative to implement a CDSS to enhance its delivery of health services. Tracking and monitoring the of quality of clinical measures has positive effects on health services delivery by creating clear organizational-wide objectives and goals. Data collection best practices are aligned with public health and federal regulatory requirements (Santilli & Vogenberg, 2015). The integrity of clinical data, such as vital signs and results from laboratory testing, is necessary for both clinical diagnoses and therapeutic health interventions. Data integrity and the validity and accuracy of clinical documentation are critical to continuity of care, medical informatics, and disease management. Medical providers and healthcare professionals are responsible for designing care delivery systems that capture clinical documentation and quality indicators. Ultimately, the internal stakeholders at Avera Health Plans decided to implement the CDSS to provide its medical staff support for clinical judgment and decision-making to improve health outcomes. This type of evidence-based-medicine shifts the strategic paradigms to better support continuity of care and long-term care planning (Smith, 2015).

Discussion

Measuring key performance indicators and clinical metrics are vital in health delivery systems. Stakeholders, including patients, payers, and providers, each have a stake in the support of quality clinical documentation and clinical efficiencies. The tracking of chronic conditions such as diabetes and obesity, which are leading causes of morbidity and mortality, is essential to the management of these conditions. At-risk population, such as the elderly, the obese, and various ethnic groups, requires access to quality primary care services and long-term care. It is essential to understand the health, social, and environmental characteristics of these special populations. Primary care, prevention intervention, quality clinical documentation, and tracking of health quality measures are fundamental components for improving health outcomes in outpatient ambulatory care services delivery models (Muecke, Curac, & Binks, 2013).

Conclusion

The goals of greater patient safety and continuity of care demand the creation of new automated workflows forged from the utilization of CDSS. These require that clinical practitioners fully utilize the built-in functionality, such as prescribing medications within EHRs. For example, Penoyer et al. (2014) found that prescribers did not thoroughly review nursing and ancillary documentation. The finding that few clinical practitioners review the plan of care may partially explain everyday problems that arise due to poor communication and fragmentation in acute health care.

Questions

1. How do outpatient services support the continuity of care in the delivery of health services?

2. Why is clinical documentation important in supporting evidence-based-medicine?

3. Research and analyze two clinical quality measures that are mandatory for outpatient ambulatory care delivery.