1. Component 1: Introduction to Health Care and Public Health in the U.S.
Unit 2: Delivering Health Care
Lecture 3
This material was developed by Oregon Health & Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC

2. Objectives of This Lecture
Describe the structure and function of outpatient clinics and hospitals, including their clinical and administrative setup
Entities include:
Individual and group physician practices
Health maintenance organizations (HMOs), preferred provider organizations (PPOs)
Urgent or immediate-care clinics
Hospitals
Hospital systems
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3. Sole Proprietorship Clinic
Functions as a small private office
Run by a single physician with a small staff
Owner assumes all obligations/liabilities
This type of practice is increasingly rare
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4. Health IT Workforce Curriculum
Group Practice Clinic
Partnership includes 2 or more physicians
Corporate group practice: a corporation owns the practice, and physicians are employees
Independent Practice Association (IPA)
Practice is a legal entity (e.g., corporation)
Each physician has a separate office
Physicians own the practice
May contract with HMOs to provide health care
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5. Health IT Workforce Curriculum
Managed Health Care
HMO
Provides discounted health care via provider network
Physicians are paid per patient
Patient gives co-payments for service, obtains referrals for specialty care
PPO
Similar to an HMO, but physicians are independent
Patient pays fees but does not need referrals
Point-of-service plan
Works as a combination of HMO and PPO
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6. Health IT Workforce Curriculum
Urgent Care Centers
Also called immediate care centers
For acute illness or injury not serious enough for a hospital emergency room (ER)
Capability is intermediate between retail clinic and ER
Service is available on walk-in basis
Extended hours
Advantageous for U.S. health care system
Provide more health care for more people
Reserve ERs for life-threatening emergencies
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7. Community Health Centers
Provide primary care for disadvantaged people
Treat those who cannot pay and/or have no insurance (e.g., poor, homeless, migrant workers)
Found in all 50 states and territories
Usually rely on public financing
Advantageous for U.S. health care system
Improve health care access for all
Reserve ERs for true emergencies
Community mental health centers also exist
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8. Health IT Workforce Curriculum
Community Hospitals
Defined as non-federal, short-term, general public hospitals
Provide general or specialty care
Operate on for-profit or nonprofit basis
Advantageous for U.S. health care system
Well-suited for routine illness/surgery
Provide accessible, low-cost care
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9. Teaching/Research Hospitals
Large institutions affiliated with medical schools
Employ state-of-the-art medications, surgical procedures, equipment, technology
Treat complex medical problems, rare diseases
Teach physicians and other health care providers
Support and perform medical research
Provide critical care for the community
Accept uninsured patients
Example: Massachusetts General Hospital
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10. Critical Access Hospitals
Certified for reimbursement by Medicare
Hospitals must be eligible and approved
Typically are licensed acute-care hospitals in rural locations
Sometimes health clinics are eligible
Reimbursement may save the hospital from closing
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11. Health Care Accreditation
Joint Commission certifies medical care facilities
Oldest and largest health care accrediting body
Independent nonprofit organization
Evaluates more than 18,000 U.S. health care organizations and programs of all types
Goal is to improve effectiveness, safety, and value of health care
Organizations must undergo periodic site visits to identify and resolve problems
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12. Hospital Clinical Structure: Overview
Hospitals contain specialized areas
General inpatient care is provided in wards
Immediate care is provided in the ER
Surgery is performed in the operating room (OR)
Critical care is given in intensive care units (ICUs) and critical care units (CCUs)
Hospitals employ specialized personnel
Physicians and nurses provide health care
Ancillary personnel assist with technical tasks
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13. Health IT Workforce Curriculum
Hospital Setup: ER
ER is open 24 hours, 7 days a week
Treats various types of injuries
Ranging from ankle sprain to drug overdose
Severity is assessed by a process called triage
Patients are treated completely or sent to other hospital areas
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14. Health IT Workforce Curriculum
Hospital Setup: OR
Surgery is done in the OR
Sterile environment is required
Surgical team includes variety of health care workers (surgeons, nurses, anesthesiologists)
OR contains surgical instruments, monitoring equipment, emergency equipment
Surgery centers also function as ORs
Are freestanding, not part of a hospital
Perform operations on outpatient basis
Are subject to Joint Commission certification
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15. Hospital Setup: ICU/CCU
ICUs treat patients with severe disease or injury (e.g., pneumonia, traumatic injury)
CCUs are for cardiac (heart) disease
Patients come from ER, OR, or another hospital
Various interventions are performed
Sophisticated equipment is used
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16. Personnel Who Provide Serious Acute Care
Emergency medicine
Goals: save lives of patients, provide short-term care
Patients receive care accident scene by emergency medical technicians (EMTs) or paramedics, who are more highly trained than EMTs
ER care is a physician specialty
Critical care
Goals: treat life-threatening conditions, provide longer-term care
ICU and CCU care are also physician specialties
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17. Other Hospital Personnel
Surgeons perform operations, sometimes special types (for example, orthopedic surgery, plastic surgery)
Anesthesiologists monitor patients in the OR and treat pain (for example, in the ICU or during childbirth)
Other physician specialties exist (for example, internal medicine, cardiology, obstetrics/gynecology, psychiatry)
Medical subspecialties also exist (for example, pediatric cardiology)
Registered nurses (RNs), licensed practical nurses (LPNs), and physician assistants (PAs) may also specialize
Pharmacists evaluate and dispense medications
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18. Health IT Workforce Curriculum
Ancillary Personnel
Nursing assistants work under the direction of RNs and LPNs
Technicians help with treatment or diagnosis (for example, phlebotomists, x-ray and ultrasound technicians, laboratory personnel)
Therapists facilitate rehabilitation (for example, physical, occupational, respiratory, or speech)
Other workers educate and counsel (for example, dietitians, nutritionists, diabetes educators, social workers)
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19. Hospital Corporate Structure
Governing board (board of directors) provides oversight
Chief executive officer is responsible for daily operations
Administration also includes chief officers, department heads, patient care managers
Medical staff and ancillary personnel provide health care and technical services
Nonmedical services are also critical (for example, cooks, laundry workers)
Business office does paperwork (for example, billing, scheduling)
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20. Health IT Workforce Curriculum
Hospital Financing
Ownership may be public or private
Public hospitals are funded by the government, may have limited resources
Private hospitals are run by private entities, may have greater resources (for example, finances, equipment)
Either type of hospital may be for-profit or nonprofit
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21. Health IT Workforce Curriculum
Hospital Systems
A hospital system is 2 or more hospitals owned by a corporation, with a single board of directors
A network is a group of hospitals, physicians, and other entities that collaborate to provide care in a community
Example of a hospital system: Greenville Hospital System University Medical Center in South Carolina
Has multiple locations
Research and teaching organization
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22. Health IT Workforce Curriculum
Summary
Medical facilities range from single-physician offices to large hospital systems
Most of the U.S. population has a managed care plan
Community centers and clinics offer a range of services
Hospitals treat patients; also fill teaching, research, and charitable roles
All health care facilities must prove efficacy and safety
Health care providers work as a team to optimize medical care
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