Providers increasingly are shifting their focus to ambulatory care—but providers must address key challenges as they move forward, says Ann Scott Blouin, EVP of customer relations at the Joint Commission.

U.S. Census Bureau data show that ambulatory care spending grew by 7.3 percent from Q2 2015 to Q2 2016, totaling $244.3 billion. Experts say the growth is fueled in part by new value-based payment models and technology advancements.

In fact, a 2015 peer60 report concluded that the widespread adoption of EHRs and an increase in ambulatory care facilities attesting to the federal EHR incentive program are "good indicators ambulatory care is ready for primetime."

5 key ambulatory care challenges

But this shift toward ambulatory care can pose significant quality and safety challenges. Blouin outlined the top five quality and safety challenges facing ambulatory care:

• Diagnostic errors are more common: Ambulatory patients typically are scheduled for very short appointments: about one patient every 10 to 15 minutes. As such, sometimes "you have to come to conclusions without all of the information," Blouin said. She added, "If the diagnosis isn't accurate then the treatment, of course, would be incorrect."
• Infection control is more difficult: While hospitals generally know the importance of properly managing, cleaning, and sterilizing equipment, Blouin said the Joint Commission has found that it is an area in which ambulatory care clinics may struggle. Blouin also noted that ambulatory care clinics need to be prepared to respond to infectious diseases. For instance she noted that a patient with a highly infectious disease, such as Zika or Ebola, could just as likely present for care at an ambulatory clinic as a hospital, depending on the trajectory of the disease.
• Nobody really knows how well ambulatory care performs for some procedures: "Inpatient hospitals quality and safety is pretty well researched, but ambulatory care quality and safety is still a relatively young topic for research," Blouin said.
• Test results from earlier inpatient stays often go "astray": Blouin explained that, when a physician orders a test during an inpatient stay, the results sometimes aren't acted upon during an ambulatory follow-up—whether because the patient fails to comply with follow-up instructions, the test results aren't communicated to the patient, or the result ends up in the inpatient record instead of the outpatient record.
• Inpatient and ambulatory EHRs often don't talk to each other: Blouin noted that "in the ambulatory setting … (providers) don't have easy access to the complete medical record." That's because the information often comes from different providers with disparate EHRs.

Driving factors

Despite these challenges, experts believe that ambulatory care's gradual growth rate increases will continue as technology improves.

Robert Berenson, a fellow at the Urban Institute, said, "People don't want to go to the hospital if things can be performed safely out of the hospital." And technology, he explained, has significantly increased providers' ability to perform procedures outside of hospitals.

Blouin noted that technology has reshaped the industry within the span of her career: "When I first became a RN, nobody would have ever thought of doing a hip replacement or knee replacement" outside of the hospital. But today those can be done as outpatient procedures for uncomplicated patients with low risk factors.

"Technology and the advances of science has continued to help to move things to outpatient," Blouin, adding, "I do believe there will continue to be some slow but incremental growth in ambulatory."

More on ambulatory care: Join us for tips from a Joint Commission expert

To learn more about the strategies health care providers can use as they transition to ambulatory care models, join Blouin for an Advisory Board webconference on Thursday, Oct. 20. She'll detail additional challenges emerging in ambulatory care, transitions of care and care coordination, and several strategies for health care teams to consider as they move forward.