From Inpatient to Outpatient: The Evolution of Healthcare Delivery

Trends in Health Care Delivery

Studies of hospital admissions throughout the country reveal an ongoing decline which started in 2009. The changes have been small but steady. For instance, there were almost 36.2 million admissions in 2012 according to the American Hospital Association. By 2013, this fell to about 35.4 million which translates to a drop of 2%. The outpatient figures, meanwhile, show an opposite trend. This type of visit to the hospitals actually increased in the same time period to over 787 million for a rise of 1.2%. This might seem like a small percentage but the large base means that the number of people affected is nontrivial.

If we look at a broader time span, then the changes appear to be truly startling. The number of outpatient observation stays increased by 96% from 2006 to 2013. In other words, visits nearly doubled in a period of six years. A Medicare Payment Advisory Commission report released in 2015 supports these findings. This MedPac paper says that the use of outpatient services increased by 33% over the past seven years. Various events and activities are being suggested as the reason for this clear shift.

The Cleveland Clinic Health System also published its own study on the matter. They focused on the number of inpatient admissions for an 11-hospital network and found a 3.25% fall in 2014. They had 40,186 visits in 2013 which dropped to 38.880 the following year. The opposite happened on the outpatient side of things in the health system. They observed a 14.15% increase during the exact same period.

All of these changes have begun to have a tangible impact in the way that hospitals are planning to respond to patient needs. For instance, Modern Healthcare did a survey on hospital construction and design in 2014. They found that the majority of these institutions have shifted their funding in line with the trends. There is now more allocation for outpatient-based projects such as renovations of emergency departments and urgent care centers.

Goals and Expectations of Alternative Delivery Systems

A large block of the healthcare industry is responding to the changing environment by implementing much-needed reforms. Incentives are now being aligned to encourage improvement certain aspects of delivery. The primary objective is to enhance the patient experience which includes increasing the quality of care, thereby getting better satisfaction rates. They are also concerned with the development of the health of the population as a whole. They look at the community and not just the individual patients. Finally, they would like to reduce the per capita cost of healthcare. The Affordable Care Act is crucial in providing a framework for rewarding providers according to the quality of their service.

Types of Outpatient Facilities

Nurse Managed Health Centers are sites which are operated by Advanced Practice Registered Nurses. These NMHCs provide primary care to patients while focusing on the promotion of good health habits and disease prevention. They typically cater to individuals who have limited access to care regardless of their ability to pay. These clinics offer a wide variety of service including physical exams, diabetes screenings, cardiovascular checks, smoking cessation programs, osteoporosis screenings, immunizations, and the like. As of the last count, there are about 200 NMHCs scattered across 37 states. They get about two million patient encounters every year.

Ambulatory care nursing is provided in multiple settings. The nurses engaged in this type of service care for patients in environments outside of the hospitals. They have a firm focus on general health education. Ambulatory nurses are often found in telehealth service environments providing information to people who are miles away. They could be in military and veterans administration settings, colleges and educational institutions, ambulatory surgery centers, diagnostic procedure facilities, and even patient homes. They make routine visits to check on people and provide whatever assistance is required by the patients.

How Technology is Driving Evolution

Technology has had a major impact on virtually every industry including health care. Modes of delivery are changing rapidly. Nurses now have more tools that they can use to help them as they attend to patients outside of acute care settings. These include mHealth, telemedicine, and electronic health records.

mHealth brings the convenience and flexibility of mobile computing to the delivery of health services. Nurses can have all the information that they need anywhere they are so they are no longer tied to the monolithic system at the hospitals. Patients can use these as well to check on processes throughout the day. They don’t even have to go to a healthcare facility to get the info they need or the help they require. The number of mHealth apps available to consumers is now more than 165,000. These range from heart rate monitors to medication reminders.

Telemedicine is the delivery of services over long distances with the aid of technology. This often happens real-time with doctors, nurses, and patients talking to each other onscreen via the Internet. Other arrangements are also possible depending on the facilities available. Studies in this area have routinely praised telemedicine for its role in providing healthcare to isolated regions. Rural towns, for example, often lack medical experts who can diagnose and treat the sick. This technology can help bridge the gap by giving them access to urban doctors at a very low cost. They don’t have to travel far to get quality service.

Health records are increasingly becoming digitized for storage in massive databases. This makes retrieval much easier for everyone from patients to clinicians. Doctors can make better decisions regarding their patients thanks to the information that is always just a click away. Electronic health records also make care delivery more efficient as everything is streamlined. Aside from providing all the details on demand, the systems may also come with interfaces for outcomes reporting, quality management, and evidence-based decision support.

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