Health Affairs · 2010 · 281 citations · 26 references
NursingEmergency MedicineHealth PolicyHealth Services ResearchPrimary CarePrimary Care SystemsAcute Care ManagementAcute Illness ManagementHealth Care AccessPatient-centered Medical HomePrimary Care Delivery ModelsPrimary Health CareAccess To Emergency CareAccountable Care Organization AgreementsAccountable Care Organization ArrangementsPrimary Care AccessibilityPrimary Care RedesignPrimary Care Service UsePrimary Health Care AccessUrgent Care Utilization
Acute care in the U.S. is increasingly delivered outside primary care, with only 42 % of visits to personal physicians and the remainder to emergency departments, specialists, or outpatient clinics, where emergency physicians handle a quarter of encounters despite being fewer than 5 % of doctors.
Historically, general practitioners provided first-contact care in the United States. Today, however, only 42 percent of the 354 million annual visits for acute care--treatment for newly arising health problems--are made to patients' personal physicians. The rest are made to emergency departments (28 percent), specialists (20 percent), or outpatient departments (7 percent). Although fewer than 5 percent of doctors are emergency physicians, they handle a quarter of all acute care encounters and more than half of such visits by the uninsured. Health reform provisions in the Patient Protection and Affordable Care Act that advance patient-centered medical homes and accountable care organizations are intended to improve access to acute care. The challenge for reform will be to succeed in the current, complex acute care landscape.
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