Ambulatory care

Abstract

Chronic disease is one of our country’s greatest healthcare challenges and accounts for the vast majority of healthcare spending. Despite these exorbitant costs, the United States has fewer outpatient visits and higher rates of hospitalization for chronic conditions compared to other industrialized nations. This occurs in the setting of significant health disparities along socioeconomic and racial lines regarding chronic disease outcomes. This disheartening reality is motivating a dissection and analysis of the way healthcare is delivered. Shifting resources to focus on managing chronic disease in the outpatient setting is paramount to improving the lives of patients and reducing financial costs. This chapter explores outpatient care of patients with chronic diseases, models of how it is delivered, and innovations in team-based care. Emerging best practices include the patient-centered medical home model, increasing the role of care managers and the function of Accountable Care Organizations in promoting low-cost, high-quality care. Strategies for providing optimal outpatient care for chronically ill patients are examined and include prioritizing multiple complaints, medication reconciliation, preparation for crisis situations, and promoting self-management. The explosion of data analytics is rapidly shifting the climate of quality standards and quality improvement, and transformational practice models that promote continuous quality improvement will be reviewed. The importance of effective transitional care in chronic disease management is discussed, and the Coleman Model is presented as a potential solution.