Ambulatory Care

Utilization

Patient concerns or medical conditions that are addressed through ambulatory care vary widely. Nationally, about 50% of all physician visits in the United States in 2005 were due to specific symptom complaints such as respiratory or musculoskeletal issues. A general medical examination, however, was the specific reason most often cited for a physician visit, making up about 7% of all ambulatory-care visits. About 18% of all visits were for preventive-care purposes, and 33% of visits were for new conditions or infectious diseases. Through these visits, there are a wide variety of services that are offered. Diagnostic or screening services were ordered at 87% of ambulatory visits. Health education was ordered or provided at 38%, nonmedi-cation treatment (consisting of services such as physical therapy, psychotherapy, or wound care) was ordered at 18%, and surgical procedures were ordered or performed at 6% of office visits.

The Healthcare System

Ambulatory care is the primary means by which medical care is provided to the U.S. population, constituting more than 1 billion visits yearly. In 2003, this accounted for about 27% of the nation's healthcare spending. In 2005, nearly 60% of all visits were to primary-care specialists (more than 22% to generalists and family medicine physicians), and the remaining 40% of total visits split nearly evenly between surgical and medical specialists.

As the U.S. healthcare system is scrutinized and reassessed to improve its overall effectiveness, the important role of ambulatory care in the ability to improve quality and control costs is being realized. In 2004, the National Quality Forum (NQF) met to identify a set of performance measures that will be used to improve the quality of ambulatory care in furthering this ideal. The 10 priority areas that were identified include patient experience with care; coordination of care; asthma; prevention (primary and secondary, including immunization); medication management; heart disease; diabetes; hypertension; depression; and obesity. These measures have been prioritized and focused in subsequent years through the Ambulatory Care Project, which is aimed at standardizing ambulatory-care performance measures and, in doing so, improving quality in the ambulatory setting.

The Agency for Healthcare Research and Quality (AHRQ) estimates that by improving the quality of and access to primary care through projects such as the Ambulatory Care Project, the nation might be [Page 46]able to avoid more than 4 million hospitalizations each year. This could result in billions of saved healthcare dollars by enhancing access to effective treatments and focusing on prevention in an ambulatory setting in regard to chronic illnesses such as diabetes, congestive heart failure, asthma, and hypertension. It is estimated that in 2004, a total of $29 billion was spent on inpatient care for 12 potentially preventable conditions, including $2.6 billion for kidney damage due to long-standing uncontrolled diabetes and $8.3 billion for complications involving congestive heart failure. Chronic illness visits currently make up a significant portion of ambulatory-care visits, constituting about 40% of visits in 2005. However, chronic care can be greatly improved, and illness exacerbations and secondary complications can be avoided, through enhanced access to primary-care settings.

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