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Goal: Affinity is
seeking projects that improve service delivery through
redesign of ambulatory care practices.
Overview: The ambulatory setting is at the heart
of the service delivery system. Yet patients and
providers are frustrated. With respect to care-seeking
and care-giving, barriers exist on multiple levels.
Patients report care that is uncoordinated, impersonal
and unsupportive with significant delays in getting
appointments with primary care and specialty providers.
Providers are also frustrated. They often feel rushed
and not prepared to meet the complex preventive,
educational, acute and psychological needs of their
patients and their families.
The frustration level has
been increasing as the population ages and more
individuals present with multiple chronic conditions.
Research has shown that it would take physicians an
additional seven to ten hours a day to properly manage
chronic diseases in their patients. Literature has also documented opportunities
for improved adherence to well-established clinical
guidelines by providers. |
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The consequences of these barriers to care-giving and
care-seeking are well documented. A Commonwealth Fund
study found that one-third of patients with health
problems report experiencing mistakes in medical
practice, tests or medications. Over half of the
patients reported that medical mistakes occurred outside
the hospital. The IHI reports that 40% of emergency room
visits are not urgent but they occur due to the
inability to see a primary care physician; 43% of adults
reporting an urgent condition were unable to get the
care they needed and between 1997 and 2001, the percent
of people reporting an inability to obtain a timely
appointment rose from 23% to 33%. All of these
challenges are accentuated among minority populations.
In response to these frustrations, significant
innovation is occurring in the primary care delivery
setting. Strategies are focused on improved
communication, greater levels of self-care by patients
and their families, more effective use of evidence-based
guidelines and protocols, enhanced use of information
technology, improved work and process flows and more
effective scheduling systems. These innovations are
occurring with a goal of improving clinical outcomes,
patient satisfaction and efficiency, and lowering costs.
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