Ambulatory Care Organization Research Articles

Quality of care information for consumers on the Internet.

The purpose of this study was to assess the readability of quality of care information for consumers available on the Internet. Ten Internet resources for consumers, found at three major Web sites, were analyzed for readability. The scores ranged from a low of 6th grade level for information in the document "Quick Checks for Quality: Choosing Quality Health Care" to a high of 12th grade level for "Helping You Choose a Quality Ambulatory Care Organization." The overall mean reading demands of four of the documents were higher than the 8th grade level recommended for the general public. Six of the documents were at this level or below, placing them at an appropriate reading level for most consumers to understand the information.

Organization of ambulatory care provision: a critical determinant of health system performance in developing countries.

Success in the provision of ambulatory personal health services, i.e. providing individuals with treatment for acute illness and preventive health care on an ambulatory basis, is the most significant contributor to the health care system's performance in most developing countries. Ambulatory personal health care has the potential to contribute the largest immediate gains in health status in populations, especially for the poor. At present, such health care accounts for the largest share of the total health expenditure in most lower income countries. It frequently comprises the largest share of the financial burden on households associated with health care consumption, which is typically regressively distributed. The "organization" of ambulatory personal health services is a critical determinant of the health system's performance which, at present, is poorly understood and insufficiently considered in policies and programmes for reforming health care systems. This article begins with a brief analysis of the importance of ambulatory care in the overall health system performance and this is followed by a summary of the inadequate global data on ambulatory care organization. It then defines the concept of "macro organization of health care" at a system level. Outlined also is a framework for analysing the organization of health care services and the major pathways through which the organization of ambulatory personal health care services can affect system performance. Examples of recent policy interventions to influence primary care organization--both government and nongovernmental providers and market structure--are reviewed. It is argued that the characteristics of health care markets in developing countries and of most primary care goods result in relatively diverse and competitive environments for ambulatory care services, compared with other types of health care. Therefore, governments will be required to use a variety of approaches beyond direct public provision of services to improve performance. To do this wisely, much better information on ambulatory care organization is needed, as well as more experience with diverse approaches to improve performance.

Benchmarking Patient Relations within Ambulatory Care: Lessons from a High-Risk Pregnancy Program

Ambulatory care providers are being challenged to deliver high-quality care at low cost with easy access. Patient satisfaction with services hinges on the ability of providers to meet these often elusive benchmarks. This article focuses on the barriers to benchmarking patient relations in ambulatory care organizations and strategies for improving patient relations through internal benchmarking that encourages service innovation and performance emphasis. A case study of programmatic benchmarking in the Lovelace Health System is used to illustrate how patient relations can benefit from establishing internal performance thresholds that guide service delivery. Examples from Lovelace's High Risk Pregnancy Program demonstrate the value of benchmarking efforts. The implications for patient relations benchmarking in other ambulatory care settings are discussed.

The Transition From Quality Assurance to Continuous Quality Improvement in Ambulatory Care

The transition of quality assurance to continuous quality improvement (CQI) in ambulatory care organizations requires careful planning and consideration of efficiency. Ambulatory care organizations must maintain indicators to measure activities, sample the multiple encounters of ambulatory care, and truly change their internal culture. This article provides practical information that persons involved in quality management can use to plan CQI processes in ambulatory care.

Health Care Delivery

The effective delivery of comprehensive health care service to young handicapped children is a challenge for physicians and the health care profession. The field has attempted to respond to this need by expanding the options for health care delivery beyond single-physician services. New organizational arrangements—such as Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO), Tax Supported Direct Service Programs, Hospital-Based Services, Ambulatory Care Organizations, and others—have emerged to broaden the available options. This article reviews these emerging health care delivery options and compares cost structures, quality of care, and future prospects.

BOOK REVIEWS

Adult Health Management: Guidelines for Nurse Practitioners Carol E. Thompson, Jo M. Jones, Ann R. Cox, and Elizabeth Y. Levy Reston, VA: Reston Publishing Co., 1983; $13.95. Affective Education in Nursing Elizabeth C. King Rockwell, MD: Aspen Publications, 1984, 278 pp., $29.50. Community Mental Health Nursing New Directions in Theory and Practice Dixie Koldjeski New York: John Wiley & Sons, 1984, 328 pp, $20.95. Ambulatory Care Organization and Management Austin Ross, Stephen J. Williams, and Eldon L. Schafer New York: John Wiley & Sons, 1983,453 pp., $24.95. Women's Health Management: Guidelines for Nurse Practitioners Jo M. Jones, Ann R. Levy, Elizabeth Y. Levy, and Carol E. Thompson Reston, VA: Reston Publishing Co., 1984; 294 pp., $14.95

Assessing technical performance at diverse ambulatory care sites.

The purpose of the large study reported here was to develop and test methods for assessing the quality of health care that would be broadly applicable to diverse ambulatory care organizations for periodic comparative review. Methodological features included the use of an age-sex stratified random sampling scheme, dependence on medical records as the source of data, a fixed study period year, use of Kessner's tracer methodology (including not only acute and chronic diseases but also screening and immunization rates as indicators), and a fixed tracer matrix at all test sites. This combination of methods proved more efficacious in estimating certain parameters for the total patient populations at each site (including utilization patterns, screening, and immunization rates) and the process of care for acute conditions than it did in examining the process of care for the selected chronic condition. It was found that the actual process of care at all three sites for the three acute conditions (streptococcal pharyngitis, urinary tract infection, and iron deficiency anemia) often differed from the expected process in terms of both diagnostic procedures and treatment. For hypertension, the chronic disease tracer, medical records were frequently a deficient data source from which to draw conclusions about the adequacy of treatment. Several aspects of the study methodology were found to be detrimental to between-site comparisons of the process of care for chronic disease management. The use of an age-sex stratified random sampling scheme resulted in the identification of too few cases of hypertension at some sites for analytic purposes, thereby necessitating supplementary sampling by diagnosis. The use of a fixed study period year resulted in an arbitrary starting point in the course of the disease. Furthermore, in light of the diverse sociodemographic characteristics of the patient populations, the use of a fixed matrix of tracer conditions for all test sites is questionable. The discussion centers on these and other problems encountered in attempting to compare technical performance within diverse ambulatory care organizations and provides some guidelines as to the utility of alternative methods for assessing the quality of health care.

Point of view: Consumer Expectations of Ambulatory Care

Consumers will soon have ample leverage through government cost controls to force significant changes in ambulatory care organization. Now, more than ever, managers must take consumer preferences into account in both the planning and delivery of ambulatory care.

Family nutritionist on the primary health care team

For decades nutrition counseling was limited to crisis-oriented hospital clinics and public health stations and seemed destined to remain at that limited level of outpatient availability. Mid-twentieth century social changes motivated health planners to develop “innovative” ambulatory preventive health delivery systems for the general public. Some of these “innovations” included nutrition counseling as a preventive health service. In Chicago nutrition counseling is now integrated into primary, multidisciplinary ambulatory health teams in an organization of private, comprehensive health care centers. The nutritionists use attractive surroundings, interesting materials and supportive counseling techniques to encourage health consumers to improve food selection and eating behavior in areas of normal, modified and therapeutic diets. The Illinois Family Health Centers Nutrition Division is a model that can be used as an example or as a point of departure by nutritionists and health planners interested in integrating nutrition counseling services into ambulatory health care organizations.

Functions of dietetic personnel in ambulatory care1

By observation in ten ambulatory care settings and a literature review, the author found that dietetic service is being delivered by a variety of personnel--trained lay aides, nurses, and physicians, as well as professional dietitians. Employers in such settings agree that nutrition is an important component of total health care but question whether it must necessarily be delivered by dietetic personnel. The dietitian, to survive, must justify on a cost-benefit basis the unique value of her competency to the outcome of patient care. Sixty-eight nutritional care functions, appropriate for dietitians and/or dietetic technicians working in ambulatory care organizations, are identified and listed. In contrast to hospital-based, in-patient care, the author concludes that performance of these functions requires greater interest in helping others and greater flexibility, and she sees such service as the wave of the future.

An evaluation of the activities of nurses and pediatricians in a university outpatient department

A quantitative analysis of the activity of pediatricians and nurses reveals striking differences in the degree to which they function appropriately in a university outpatient department. In general, the physicians were concerned with professional patient care and education; the nurses spent more of their time in administrative and nonprofessional tasks than in nursing tasks. Such quantitative data are valuable for the proper planning of programs and allocation of resources within a pediatric ambulatory care organization.