definition of ambulatory visit

Ambulatory Care

Ambulatory care refers to any kind of care that is provided on an outpatient basis. This is the kind of health care that most people receive on a regular basis, from getting a broken bone fixed in the emergency room to visiting an internist for a diagnosis of a nagging illness. There are many different kinds of caregivers that may provide this care in a range of settings, from hospitals to clinics and private practices.

You may have a choice between inpatient and outpatient care, which means you need to be informed of risks and benefits. Doctors and other caregivers have a responsibility to provide the best care, but also to help you make the right choices. Expect the best care, regardless of your choice, and know what options you have if something goes wrong and you don’t get quality ambulatory care.

Inpatient vs. Outpatient Care

Ambulatory care is also known as outpatient care. It is any kind of care that does not require an extended stay in a health care facility. An extended stay is anything that requires staying overnight. Whether your receive inpatient or outpatient care depends on your needs. Sometimes the choice is obvious. For example, if you need major, complicated surgery, an inpatient stay in the hospital is necessary. On the other hand, if you cut your finger and need a few stitches, you can receive care and then go home to heal and rest.

Outpatient care is typically used for medical examinations, tests, and screenings used for diagnostic purposes. It is also used for rehabilitation services, like physical therapy, for treatments like radiation therapy for cancer, and for minor procedures. When the patient is able to function after a procedure, and after any anesthesia used has worn off, outpatient care is usually chosen. If a patient needs more observation, monitoring, or care after a procedure, inpatient care may be needed. Ambulatory care is often also less expensive.

Types of Ambulatory Care

This type of outpatient care can take many forms, depending on the needs of the patient. Any typical visit to a doctor’s office is considered outpatient care. This can be for a regular checkup, for an illness, or for minor procedures such as a mole removal in a dermatologist’s office. Care received at an urgent care clinic, or other type of clinic is also considered outpatient care.

Ambulatory care can take place in a hospital too. Any time you need to visit the hospital for any type of care, but do not stay overnight, you are receiving care on an outpatient basis. Reasons to be in the hospital for outpatient care include imaging tests, like X-rays or MRIs, diagnostic tests and screenings, outpatient surgical procedures, treatments like chemotherapy, or rehabilitation sessions.

Ambulatory care may also be used to treat patients with chronic conditions, as a way to prevent inpatient stays or hospitalizations. This may be a strategy used for things like chronic respiratory illnesses, cancer, or diabetes. For many patients it is a better option to be able to return home than to be hospitalized, so ambulatory care can help prevent the need for an extended stay.

Other types of ambulatory care include wellness care, alternative medicine and treatments, mental health therapy, and other therapies, such as respiratory therapy or occupational therapy. Wellness care may include meetings with a nutritionist or preventative care, while alternative treatments may include sessions of acupuncture or homeopathy. Therapy sessions, such as working with a physical therapist are outpatient sessions. Mental health care is also done on an outpatient basis, with group or individual therapy sessions.

Ambulatory Care Settings

Settings for outpatient care are numerous. Any doctor’s office or a specialist’s office can serve as a facility for ambulatory care. A hospital may provide outpatient care, and some even have an outpatient center separate from other units in the hospital. Urgent care clinics, family planning clinics, mental health care facilities, and therapy offices, are also settings where patients may receive ambulatory care. There are also many ambulatory centers that are set up for specialized care, including cancer centers, cardiology centers, or pain management to name just a few examples.

Ambulatory Surgery

When you need to have a surgical procedure you may have a choice between hospitalization and outpatient surgery. To make the right decision, be sure to talk to your regular doctor and your surgeon about the benefits and risks of each option. If there are few risks of not being hospitalized, outpatient surgery is often a popular choice.

With ambulatory surgery you spend less time in the health facility and more time at home where you are likely to be more comfortable. Outpatient care is also typically less expensive. Another reason to choose ambulatory surgery is that it is often performed at specialized facilities where the staff is experienced in caring for patients with your specific needs, such as plastic surgery or orthopedic surgery. One reason to choose inpatient surgery may be if you do not have anyone to care for you or help you at home while you recover.

Follow up for Ambulatory Care

Good quality ambulatory care should not end once the care is given. Most care offered on an outpatient basis requires some type of follow up and it is the responsibility of your caregivers to inform you of what is needed. If you have had surgery, for instance, you need follow up appointments to ensure the wound is healing and is not infected. For a diagnostic screening, like an MRI, you need a follow up appointment to review the results and receive a diagnosis or to determine if you need more testing.

Ambulatory care is an important part of health care because it provides patients with a type of care that is efficient, timely, and effective if provided by diligent health care professionals. If you have a choice between inpatient and outpatient care, there are pros and cons on both sides. Make sure you have all the information before you make a decision and rely on the expertise of your doctors in making that choice. If you do receive ambulatory care, know what care you are entitled to and act if you think you have not received the best care.

• http://www.pbmchealth.org/blog/difference-between-inpatient-and-outpatient-care/
• https://www.aaacn.org/about/what-ambulatory-care-nursing
• https://www.jointcommission.org/accreditation/ambulatory_healthcare.aspx
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What is Ambulatory Care? Learning More About the Future of Healthcare

By Anna Heinrich on 09/19/2017

Today, you can have surgery on your gallbladder, knee or wrist and be back at home within hours, without ever having checked into a hospital. Fifty years ago, you could expect to be in the hospital for up to 10 days after delivering a baby. Now, you may be able to go home the same day. Crazy, isn’t it?

Same-day surgeries and services are the beginning of a new trend in healthcare: Ambulatory care. Also known as outpatient care, ambulatory services have been consistently on the rise. From 2000 to 2004, the percent of registered nurses working in ambulatory care grew five percent, while the percentage of registered nurses working in hospitals dropped four percent. This shift in the healthcare field affects you as a patient and as a future healthcare professional. But what is ambulatory care? We broke it down so you can understand what it is and why it is the future of healthcare.

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What classifies as ambulatory care?

Ambulatory care can be a misleading term, as it actually encompasses a wide range of care and services. By definition , ambulatory care is any same-day medical procedure performed in an outpatient setting. This refers to any medical service that is not performed in a hospital or facility that requires admission. We can further divide ambulatory care into four smaller sub-categories to better help you understand all that ambulatory care encompasses:

This is normally what you think of when you imagine going to the doctor. Ambulatory wellness services are mostly for prevention and basic medical care. They include doctor’s clinics, such as primary care, as well as counseling centers for mental health and weight loss.

Diagnostic services can be provided on their own, or as part of a wellness or treatment program. They include X-Rays, lab and blood tests, MRIs and screening for various cancers and illnesses.

These include same-day surgery centers, substance abuse clinics, chemotherapy and other forms of therapy.

Rehabilitation

Rehabilitation includes post-operative therapies, occupational and physical therapy and rehabilitation for drug and alcohol abuse.

In addition to these procedures and services, ambulatory care encompasses newer forms of healthcare, such as telemedicine. Telemedicine allows doctors and nurses to “see” and interact with patients via email, phone and video-chatting. Amelia Roberts, BSN RN , uses telemedicine to assess her patients.

“Ambulatory care is different from hospital care in that my assessments happen via phone and email. My questions have to be very specific as I am not there to make vital observations,” Roberts says.

Who works in ambulatory care?

Ambulatory care, while outside of a hospital, employs almost all of the same healthcare professionals as inpatient care. Doctors, registered nurses, LPNs, physical therapists, physical therapy assistants, surgical techs, medical lab techs and medical administration staff can all be found in various ambulatory care settings.

While no further training or education is needed to work in an ambulatory care setting, nurses can specialize to become an ambulatory care nurse (ACN) . Nurses who work in ambulatory care often have more predictable schedules than nurses who work in hospitals. In addition, there are fewer emergencies and complications in outpatient care, making ambulatory care nursing perfect for nurses who don’t want the added stress of working in an emergency room or a large hospital.

How is ambulatory care shaping healthcare?

Hospitals are diverting many services to outpatient facilities. In 2008 , outpatient visits rose from 624 million to 675 million. So there’s no doubt that ambulatory care is growing and expanding into the traditional hospital space, but why and how does it affect patient care?

Justin Yeung, MD and CEO of ShareSmart , says, “Ambulatory care is growing in popularity because it is a money-saving measure for hospitals. Inpatient hospital stays are extremely costly and demand a lot of resources.”

To further that reasoning, Roberts says the current financial structure is “not sustainable” and compares current hospitalization costs and conditions to “a very expensive hotel room.” Ambulatory care offers hospitals a cost-effective alternative: They can provide the same services to patients at a fraction of the cost and in a fraction of the time.

With the implementation of the Affordable Care Act , hospitals have been pressed to cut costs and make healthcare more accessible and affordable to all. Ambulatory care provides a solution to both of these. As hospitals begin to turn to outpatient care, patients can expect to see a future of quick, same-day health services.

How does it affect you?

The increase in ambulatory care services and providers is a good thing for you as a patient and a future healthcare professional.

“Having worked in in-home care for many years, I can say that I would always prefer to work on an outpatient basis,” says Eddie Chu of Qualicare. “It addresses both physical and emotional needs and, therefore, provides a more attentive and well-rounded health service looking at the full picture.”

Besides more personalized care, patients who receive outpatient services are able to go home and resume their normal lives and activities more quickly. No overnight hospital stays means more time saved for patients and healthcare professionals alike.

In addition, the costs saved from having overnight stays reveals itself in lower medical bills. Doctors and nurses are also able to hold more routine schedules—no crazy overnights, and some who work in clinics may even have holidays and weekends off.

Be the future

As hospitals transition to more outpatient facilities, traditional healthcare positions will be shifting. According to the Bureau of Labor Statistics , employment in outpatient care centers is projected to grow 49 percent from 2014 to 2024. Where do you see yourself fitting into this new healthcare dynamic?

Now that you know more about what ambulatory care is and how it is shaping the future of healthcare, compare and contrast two of the most in-demand healthcare settings with our article, Acute Care vs. Ambulatory Care: Which Nursing Environment is Right for You? With so many nursing specialties and settings available, it’s worthwhile to look into all of your options, so you can excel in this exciting and changing field.

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Defining Ambulatory Care

Ambulatory care refers to medical services performed on an outpatient basis, without admission to a hospital or other facility (MedPAC). It is provided in settings such as:

• Offices of physicians and other health care professionals
• Hospital outpatient departments
• Ambulatory surgical centers
• Specialty clinics or centers, e.g., dialysis or infusion
• Urgent care clinics

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Definition of ambulatory

 (Entry 1 of 2)

Definition of ambulatory  (Entry 2 of 2)

• gallivanting
• galavanting
• perambulatory
• peripatetic

Examples of ambulatory in a Sentence

These examples are programmatically compiled from various online sources to illustrate current usage of the word 'ambulatory.' Any opinions expressed in the examples do not represent those of Merriam-Webster or its editors. Send us feedback about these examples.

Word History

borrowed from Middle French & Latin; Middle French ambulatoire "movable, without fixed residence," borrowed from Latin ambulātōrius "movable, transferable, suitable for walking," from ambulāre "to go by foot, walk for pleasure or health, travel" + -tōrius, deverbal adjective suffix originally forming derivatives from agent nouns ending in -tōr-, -tor ; (sense 1b) after German ambulatorisch — more at amble entry 1

earlier ameltori, amlatorye, borrowed from Medieval Latin ambulātōrium, noun derivative from neuter of Latin ambulātōrius "movable, suitable for walking" — more at ambulatory entry 1

1598, in the meaning defined at sense 2

15th century, in the meaning defined above

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ambulatorial

Cite this Entry

“Ambulatory.” Merriam-Webster.com Dictionary , Merriam-Webster, https://www.merriam-webster.com/dictionary/ambulatory. Accessed 29 Mar. 2024.

Kids Definition

Kids definition of ambulatory, medical definition, medical definition of ambulatory, legal definition, legal definition of ambulatory.

Latin ambulatorius , literally, movable, transferable, from ambulare to walk, move, be transferred

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What Is Ambulatory Care?

• Breaking down ambulatory care
• What is an ambulatory care setting?
• What types of services do ambulatory care centers provide?

Who is behind ambulatory care?

Common challenges within ambulatory care and potential solutions.

According to Merriam-Webster, ambulatory refers to the ability to be mobile and move from place to place, commonly through walking. In the healthcare industry, this term is widely used as a descriptor for the care provided to patients that are not bedridden, as well as outpatients and their procedures.

Breaking down Ambulatory Care

One will often find the phrases “ambulatory care” and “outpatient care” used interchangeably among those within the medical community. Simply put, outpatients and their care refer to medical services provided or performed outside of a hospital or facility requiring total admission. Thus, ambulatory care refers to any same-day medical procedures performed in such outpatient settings. These centers are diverse in their specialties and often provide a holistic variety of services across all aspects of healthcare. Breaking down some of these standard services will help one better understand these centers’ pervasive and essential nature.

Check out these articles after you’re done

• Ambulatory surgery center vs outpatient hospital
• How to improve workflow in ASC
• How do ambulatory surgery billing center works?

What is an Ambulatory Care Setting?

An ambulatory care setting is a healthcare facility that provides outpatient services to patients who do not require admission to a hospital. Ambulatory care centers are designed to provide timely, cost-effective, and coordinated care, focusing on preventive services and managing chronic conditions. Examples of mobile care settings include clinics, urgent care centers, outpatient surgery centers , diagnostic centers, and physician offices. Here are some examples of ambulatory care settings:

• A primary care physician’s office, where patients can go for regular checkups, vaccinations, and treatment of minor illnesses and injuries.
• An urgent care clinic that treats non-emergency illnesses and injuries, such as sprains, strains, and infections.
• An ambulatory surgery center, where patients can have minor surgeries, such as cataract surgery or knee arthroscopy, without having to stay overnight in a hospital.
• A hospital outpatient department, where patients can go for follow-up appointments after a hospitalization or to receive specialized care, such as cancer treatment or physical therapy.
• A community health center that provides healthcare services to low-income and uninsured patients.
• A school-based health clinic that provides healthcare services to students.
• A telehealth clinic that provides healthcare services to patients using video conferencing or other telecommunications technology.

What types of services do these centers provide? 

Some standard services ambulatory care centers provide include blood tests, biopsies, x-ray imaging, CT scans, ultrasounds, colonoscopies, mammograms, minor surgical procedures, radiation treatments, and chemotherapy. Such a wide array of services strikingly stretches across multiple healthcare focal points, from overall wellness to diagnoses and treatments; these centers undeniably provide many essential life-saving health services.

Ambulatory wellness services are meant for prevention and primary medical care. These are services mainly associated with visits to physician-run clinics, such as one’s primary care doctor, mental health counseling resources, and weight loss centers.

Outside of prevention, the importance of diagnostic services, such as x-rays, patient lab work, MRIs, etc., are invaluable for early screening, detection, and thus treatment of various illnesses. These treatments can range from same-day surgeries at designated ASCs, to cancer-fighting chemotherapies at specialized clinics and substance abuse counseling and rehabilitation.

However, such rehabilitation services do not stop at the gates of substance abuse. Ambulatory care centers often include many rehabilitation-focused services, including postoperative therapies and occupational and physical therapy. And with the rise of technological advancements and telemedicine, many of the services provided by ambulatory care are more accessible than ever before.

Some of the most common services provided by ACCs include:

• Preventive care:  ACCs can provide routine checkups, immunizations, and screenings for chronic diseases such as diabetes, hypertension, and cancer.
• Acute care:  ACCs can treat minor illnesses and injuries, such as colds, flu, and cuts.
• Chronic disease management:  ACCs can provide ongoing care and support for patients with chronic diseases such as diabetes, heart disease, and arthritis.
• Diagnostic services:  ACCs can perform a variety of diagnostic tests, such as blood tests, imaging studies, and biopsies.
• Minor surgical procedures:  ACCs can perform a variety of minor surgical procedures, such as cataract surgery, colonoscopy, and knee surgery.

Ambulatory Care vs Acute Care 

Ambulatory care differs from acute care in that critical care is provided to patients who require hospitalization for a severe or life-threatening condition. Acute care focuses on diagnosing, treating, and managing acute illnesses or injuries. In contrast, ambulatory care is focused on providing preventive care, managing chronic conditions, and addressing minor acute diseases or injuries.

What is Ambulatory Surgical Care? 

Ambulatory surgical care, also known as outpatient or same-day surgery, refers to surgical procedures that do not require an overnight stay in a hospital or other inpatient healthcare facility. Instead, patients receive surgical care in an ambulatory surgery center (ASC) or other outpatient surgical facility and return home on the same day as their surgery.  ASC documentation requirements  are crucial in this setting to ensure that all procedures, patient interactions, and billing processes are accurately recorded and compliant with relevant regulations.

Ambulatory surgical care is used for a wide range of surgical procedures, including diagnostic tests, minor surgeries, and some significant surgeries that can be performed safely on an outpatient basis. Examples of operations that may be performed in an ASC include cataract surgery, hernia repair, and knee arthroscopy.

Ambulatory surgical care is generally preferred over inpatient surgery for several reasons. It is often less expensive than inpatient surgery since it does not require an overnight stay or the use of other inpatient resources. Additionally, ambulatory surgery centers often provide a more comfortable and convenient patient setting, shorter wait times, and more personalized care.

However, not all patients are candidates for ambulatory surgical care. Patients with certain medical conditions or who require more complex surgical procedures may require inpatient surgery in a hospital or other inpatient healthcare facility. Healthcare providers will evaluate each patient’s needs and medical history to determine the most appropriate setting for their surgical care.

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The Connection Between Ambulatory Care and Chronic Disease Management

Chronic diseases are the leading causes of death and disability in the United States, accounting for 70% of all deaths and 86% of all healthcare costs. Ambulatory care is critical in managing chronic diseases and providing patients with access to preventive care, screening, and treatment.

How does ambulatory care support chronic disease management?

Ambulatory care providers (ACPs) can provide a variety of services to help patients manage their chronic diseases, including:

• Preventive care: ACPs can help patients identify their risk factors for chronic diseases and develop plans to reduce their risk. This may include recommending lifestyle changes, such as quitting smoking, eating a healthy diet, and exercising regularly.
• Screening: ACPs can screen patients for chronic diseases, such as diabetes, hypertension, and cancer. Early detection is essential for effective treatment and management of chronic diseases.
• Treatment: ACPs can treat chronic diseases with medications, lifestyle counseling, and other therapies. They can also coordinate care with specialists and other healthcare team members.
• Chronic diseases account for 70% of all deaths and 86% of all healthcare costs in the United States.
• Ambulatory care settings account for over 80% of all healthcare visits in the United States.
• Patients with chronic diseases make up the majority of ambulatory care visits.
• Ambulatory care can provide many benefits for patients with chronic diseases, including improved access to care, continuity of care, patient-centered care, and reduced costs.

What is an Ambulatory Care Pharmacy?

An ambulatory care pharmacy is a specialized pharmacy that provides medication management services to patients in an ambulatory care setting. This may include medication therapy management, reconciliation, and patient education on proper medication use. Ambulatory care pharmacies also work closely with healthcare providers to ensure patients receive safe and effective medication regimens.

Which Category is Used to Report Services for Patients Seen in Stand-Alone Ambulatory Care Centers?

Healthcare providers and facilities must use the appropriate Category of Service (COS) code to accurately report the services provided when submitting claims for reimbursement for services provided in stand-alone ambulatory care centers. This ensures that claims are processed correctly and that patients receive the appropriate refund for their healthcare services. COS code 49 is used for ambulatory care centers not associated with a hospital or other inpatient facility, including freestanding clinics, urgent care centers, and other outpatient healthcare facilities. Using the correct COS code distinguishes these services from services provided in hospitals or other inpatient facilities, which are reported using different COS codes.

Benefits of Ambulatory Care

Ambulatory care benefits patients, healthcare providers, and the healthcare system. These benefits include improved access to care, reduced healthcare costs, increased patient satisfaction, and better management of chronic conditions. Ambulatory care also helps reduce the burden on hospital emergency departments by providing more appropriate care for patients with minor acute illnesses or injuries.

Which Organization (s) Accredit Ambulatory Care and Physician Office Settings?

In the United States, several organizations accredit ambulatory care and physician office settings. These organizations help to ensure that these facilities meet certain quality and safety standards in their patients’ care. Some of the major accrediting organizations for ambulatory care and physician office settings include:

• The Joint Commission is the largest accrediting Organization for healthcare facilities in the United States. The Joint Commission offers accreditation for various healthcare settings, including ambulatory care and physician office settings.
• Accreditation Association for Ambulatory Health Care (AAAHC): This Organization focuses on accrediting ambulatory healthcare facilities. The AAAHC has been accrediting ambulatory care facilities since 1979 and has certified thousands of facilities across the United States.
• National Committee for Quality Assurance (NCQA) accredits physician practices and medical homes. The NCQA focuses on ensuring that these practices provide high-quality, patient-centered care.
• American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) accredits ambulatory surgery facilities. The AAAASF ensures that these facilities provide safe, high-quality surgical care.
• Healthcare Facilities Accreditation Program (HFAP): This Organization is one of the oldest accrediting organizations in the United States and offers accreditation for a wide range of healthcare facilities, including ambulatory care and physician office settings.

These accrediting organizations use various standards and criteria to evaluate and accredit healthcare facilities. Their accreditation is widely recognized as a mark of quality and safety in the healthcare industry.

So, now that the “What” behind ambulatory care has been established, it will be pretty beneficial also to show the “Who” behind such care. Ideally, ambulatory care centers, such as ambulatory surgical centers (ASCs), are managed by highly-trained professional health personnel, including nurses, physicians, radiographers, administrators, and health technicians. Not only must professionals oversee the practice of the life-saving medicine their patients need, but they must also keep an ambulatory care-centered practice running smoothly to do so. Consequently, running a thriving ambulatory care center is not without its challenges.

What Would Nursing Function be Most Commonly Found in an Ambulatory Care Facility?

In an ambulatory care facility, nursing functions can vary depending on the type of facility and the services provided. However, some of the most common nursing functions found in ambulatory care settings include the following:

• Patient Assessment: Nurses in ambulatory care facilities often perform initial assessments of patients, which includes taking vital signs, reviewing medical history, and documenting current symptoms. This helps providers make an accurate diagnosis and develop a treatment plan.
• Patient Education: Ambulatory care nurses are critical in educating patients about their health conditions, medications, and self-care practices. They provide information on preventive measures, lifestyle modifications, and how to manage chronic conditions.
• Medication Administration: Nurses in ambulatory care facilities are responsible for administering medications to patients, ensuring correct dosages, and monitoring for any adverse effects.
• Coordination of Care: Ambulatory care nurses collaborate with other healthcare professionals, including providers, pharmacists, and social workers, to ensure patients receive comprehensive and coordinated care.
• Patient Follow-up: Nurses in ambulatory care settings often follow up with patients to monitor their progress and adjust treatment plans as needed. They may also schedule appointments, order tests, and refer patients to other healthcare providers if necessary.

It is essential to address the common challenges one might encounter within ambulatory care, as they will often affect both those providing service and those on the receiving end, creating the problem of patient risk. Some recurrent hazards that affect patient safety in ambulatory care settings include diagnostic testing errors, medication mistakes, and security-related incidents.

Patients can experience several negative consequences due to diagnostic testing errors , such as missed or delayed (potentially life-saving) diagnoses, delayed interventions, and duplication of services. Another common yet unnece sary source of mistakes in ambulatory care is the prevalence of medication errors , which can occur both in prescription and maintenance.

Luckily, all of these errors and the subsequent challenges they create for an ambulatory care center can be prevented and solved through the emergence of advanced managerial technologies, such as EMRs (electronic medical records), meant to streamline such processes to take the error out of humans, resulting in safer and more efficient patient care. One such cutting-edge technology is the unique, autonomous, and user-friendly EMR known as Ambula. Unlike traditional, outdated EMRs, Ambula’s unmatched customization features, such as the modern form builder and distinctive workflow designer, allow users to completely tailor the workflow of an ambulatory practice to meet the specific needs each specialty requires to treat their patients effectively.

To limit diagnostic testing errors, an ambulatory care center should consider some of the following preventative measures, all of which Ambula’s EMR can aid in achieving:

• They are setting up decision support tools to help clinicians order appropriate tests.
• We are organizing guidelines for standard operating procedures, such as specimen collection, preparation, and delivery.
• It establishes processes for communicating test results, such as a chain of command with reporting provisions and a hierarchy of task delegations. All of these measures can help prevent life-threatening errors in a center.

Some preventative methods meant to reduce medication errors that Ambula’s EMR can assist with include tasks such as:

• We identify priority areas for medication safety improvements, such as medication-event reporting and education.
• It establishes procedures that feature the best practices for each phase of the medication management process.
• I am organizing and solidifying the management processes for high-alert medications, such as chemotherapy drugs, including storage and administration outlines.

The benefits of Ambula’s customizable EMR options go beyond preventing and minimizing common practice errors and deepening the real-life, everyday effects that save lives. To learn more about how Am ula can improve the efficiency and ease with which one’s ambulatory care practice runs, please get in touch with the Ambula Healthcare team at (818) 308-4108.

FAQ About This Article

Is there a difference between ambulatory care and urgent care.

While both terms involve outpatient care, there’s a key distinction:

• Ambulatory care:  Scheduled appointments for preventive care, managing chronic conditions, or treating non-emergency issues. This typically involves a referral from your primary care physician or a specific specialist.
• Urgent care:  Walk-in clinics for immediate attention to non-life-threatening but urgent conditions that require prompt medical attention beyond what you can wait for at your primary care doctor’s office. These conditions may include sudden injuries, illnesses with worsening symptoms, or situations requiring immediate evaluation but not severe enough for the emergency room.

Where is ambulatory care provided?

Ambulatory care can be delivered in various settings, such as:

• Primary care physician’s offices: These are your regular doctors’ offices where you go for checkups, vaccinations, and treatment of minor illnesses and injuries. In the US, over 80% of all physician visits occur in primary care settings. [Source: American Academy of Family Physicians]
• Urgent care centers: These clinics treat non-life-threatening conditions that require immediate attention but aren’t severe enough for the emergency room. There are over 10,000 urgent care centers in the US, with visits increasing by an average of 7.6% annually since 2011. [Source: Urgent Care Association of America]
• Outpatient surgery centers: These facilities perform surgical procedures that don’t require an overnight stay. Outpatient surgeries account for over 80% of all surgical procedures in the US. [Source: American Society of Anesthesiologists]
• Specialty clinics: These centers focus on specific medical conditions, such as cardiology, oncology, or mental health.
• Diagnostic centers: These facilities provide imaging services like X-rays, MRIs, and CT scans.

Who can benefit from ambulatory care?

Ambulatory care is suitable for a wide range of individuals, including:

• People seeking preventive care and routine checkups.
• Patients with chronic conditions requiring ongoing management.
• Individuals with non-emergency illnesses and injuries.
• Those needing specific diagnostic tests or minor surgical procedures.

What happens after my ambulatory care visit or procedure?

• You will receive specific instructions regarding medication, follow-up appointments, and any activity restrictions.  It’s crucial to follow these instructions carefully to ensure proper recovery and avoid complications.
• The provider may recommend additional tests or consultations if needed.  Depending on your condition and the outcome of your visit, further tests or specialist consultations might be necessary.
• Don’t hesitate to contact your provider if you experience any concerning symptoms or have questions after your visit. This is especially important if you experience any unexpected pain, swelling, fever, or other unusual symptoms.

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Inpatient vs. Outpatient: Comparing Two Types of Patient Care

More than ever, patients are engaged in their medical care, which is encouraging when you consider most medical school mission statements emphasize patient communication and education. It’s also worth noting that research shows providers are able to drive positive patient outcomes using a teach-back method that involves caring and clear language. Yet even well-informed individuals lack some knowledge, such as the distinction between inpatient versus outpatient care.

So what’s the difference, and why does it matter? This overview can help you advance your health literacy.

Inpatient vs. outpatient: Distinguishing the differences in care

What is an inpatient ? In the most basic sense, this term refers to someone admitted to the hospital to stay overnight, whether briefly or for an extended period of time. Physicians keep these patients at the hospital to monitor them more closely.

With this in mind, what is outpatient care? Also called  ambulatory care , this term defines any service or treatment that doesn’t require hospitalization. An annual exam with your primary care physician is an example of outpatient care, but so are emergent cases where the patient leaves the emergency department the same day they arrive. Any appointment at a clinic or specialty facility outside the hospital is considered outpatient care as well.

While there’s a clear difference between an inpatient and an outpatient, there is a little bit of gray area as well. Occasionally, physicians will assign a patient  observation status while they determine whether hospitalization is required. This period typically lasts for no more than 24 hours.

Also note that the location itself doesn’t define whether you’re an inpatient versus outpatient. It’s the duration of stay, not the type of establishment, that determines your status.

Inpatient vs. outpatient: Comparing services

You’re probably starting to get a sense of the varying circumstances that fit under each category. To further recognize the difference between inpatient and outpatient care, review the below treatments and services that are common for these two types of care.

Inpatient care examples

• Complex surgeries, as well as some routine ones
• Serious illnesses or medical issues that require substantial monitoring
• Childbirth, even in cases that don’t require a cesarean section
• Rehabilitation services for psychiatric illnesses, substance misuse, or severe injuries

Outpatient care examples

• X-rays, MRIs, CT scans, and other types of imaging
• Lab tests, such as bloodwork
• Minor surgeries, particularly ones that use less invasive techniques
• Colonoscopies
• Consultations or follow-ups with a specialist
• Routine physical exams
• Same-day emergent care, often treated at an urgent care facility versus the ER
• Chemotherapy or radiation treatment

Inpatient vs. outpatient: The providers in each setting

Primary care physicians  have traditionally been considered outpatient providers, while specialists are thought of as inpatient physicians. But that’s really an oversimplification, particularly when you consider that  hospitalists bridge the gap  by providing general medical care to inpatients. Effective care requires that doctors work together and effectively leverage health care technology , regardless of their specialties and settings.

Many physicians also divide their time between inpatient and outpatient services. OB/GYNs , for example, provide inpatient care when delivering babies and outpatient care when consulting with pregnant women during prenatal checkups.

Generally speaking, inpatients have contact with a larger group of providers. During a hospital stay, you could interact with physicians, nurse practitioners, lab technicians, physical therapists, pharmacists, and physician assistants.

Inpatient vs. outpatient: Cost considerations

The difference between inpatient versus outpatient care matters for patients because it will ultimately affect your eventual bill.

Outpatient care involves fees related to the doctor and any tests performed. Inpatient care also includes additional facility-based fees. The most recent cost data included in the Healthcare Cost and Utilization Project from the Agency for Healthcare Research and Quality (AHRQ) shows the average national inpatient charges can vary considerably depending on the length of stay and the treatment involved. The exact amount you pay also hinges on your insurance.

Things get a little more complicated  if you have Medicare . Outpatient care and physician-related services for inpatient care are covered by Part B. Hospital services like rooms, meals, and general nursing for inpatients are covered by Part A.

But if you stay overnight in the hospital under observation status, Medicare still considers you an outpatient and will not cover care in a skilled nursing facility. It can certainly be confusing, so don’t be afraid to ask the medical team about your status. They’re used to these types of questions.

Expand your medical knowledge

Hopefully, you now have a little more clarity concerning the definition of inpatient versus outpatient. It can go a long way towards helping you understand what you should expect during and after any sort of medical treatment.

You can further deepen your understanding of the health care world by reading our article “50 Must-Know Medical Terms, Abbreviations, and Acronyms .”

*This article was originally published in June 2019. It has since been updated to reflect information relevant to 2021.

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Outpatient visit

Measured differently in the following data systems:

American Hospital Association

Defines outpatient visits as visits for receipt of medical, dental, or other services at a hospital by patients who are not lodged in the hospital. Each appearance by an outpatient to each unit of the hospital is counted individually as an outpatient visit, including all clinic visits, referred visits, observation services, outpatient surgeries, and emergency department visits.

National Hospital Ambulatory Medical Care Survey

Defines an outpatient department visit as a direct personal exchange between a patient (not currently admitted to the hospital) and a physician or other health care provider working under the physician’s supervision for the purpose of seeking care and receiving personal health services.

(Also see Sources and Definitions, Emergency department or emergency room visit ; Outpatient department .)

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Understanding Ambulatory Surgery

Ambulatory typically means “the ability to walk” but in the context of surgery, it refers to patients who are able to leave the hospital the same day as the surgery, without being admitted to the hospital. Ambulatory surgery is referred to by other names, commonly called minimally invasive surgery, outpatient surgery or same-day surgery. When you hear someone refer to same-day surgery, they mean an ambulatory procedure.

While minimally invasive surgery is technically laparoscopic surgery , the term is often used interchangeably with ambulatory surgery. Minimally invasive procedures are surgeries that are performed using the smallest incisions possible so that the body is able to heal more quickly. These procedures are often called “keyhole” or laparoscopic surgeries. While they are designed to decrease healing times, these procedures are not necessarily same-day procedures, in fact, many require at least an overnight hospital stay .

A colonoscopy is not technically a surgery but is often referred to as an ambulatory procedure because the patient does have anesthesia and is able to go home the same day.

Typical Ambulatory Surgeries

Most ambulatory surgery procedures are minor surgeries that do not require extended recoveries. Once the patient wakes from anesthesia and is awake and alert, if no signs of problems are present and the patient is able to urinate and pass gas, they can continue their recovery in their own home. Many dental procedures are ambulatory surgeries, such as having wisdom teeth removed. Also, quick surgeries that require small incisions, such as carpal tunnel release , are typically done as outpatient surgeries.

The typical same-day surgery is usually a surgery that can be performed relatively quickly, is low risk, requires a small incision or no external incision, and has a short recovery period.

Where Ambulatory Surgeries Can Be Performed

Outpatient procedures are typically performed in one of two types of facilities: a hospital or a surgery center. 

Ambulatory surgery centers are free-standing facilities with operating rooms, but they are not hospitals. These centers perform procedures that allow the patient to recover at home once anesthesia has worn off and the patient is able to care for themselves with minimal assistance.

Patients with complications that require hospitalization would be transferred to another facility for treatment when it becomes clear that they need a higher level of care. If a patient is unexpectedly too sick to go home after surgery they can transfer to the hospital for admission and care overnight or longer, depending on the patient’s needs.

Ambulatory surgery centers typically have a relationship with at least one hospital in the community where a patient can be transferred if complications arise during the procedure or during the hours after the surgery.

Who Is Not a Good Candidate for Surgery at a Surgical Center

If you, or your loved one, had a bad reaction to anesthesia in the past, consider having surgery at a hospital. While the cost may be higher, it is important to have the full capabilities of the hospital immediately available if needed. The same is true of patients who are high risk, it is always better to err on the side of caution and not need the hospital than need it and not have it.

Patients who have a history of being difficult to remove from the ventilator should have surgery in a hospital, as should individuals with serious heart, lung and bleeding issues.

Your surgeon should tell you if you are in a risk category high enough that you should have your procedure as an inpatient in a hospital, but you may still want to ask if you have any concerns. With some insurance plans, there may be no cost difference between different inpatient surgery and outpatient surgery.

A Word From Verywell

If you are well enough to have ambulatory surgery, congratulations! Having a procedure and returning home on the same day can reduce the stress of surgery by allowing you to recover in your own home once the anesthesia wears off. Many patients prefer to recover at home, and can do so safely and without any additional complications or issues.

If you have any issues that seem like they might be serious, be sure to reach out to your surgeon or seek medical attention.

American Society of Anesthesiologists. Outpatient surgery .

By Jennifer Whitlock, RN, MSN, FN Jennifer Whitlock, RN, MSN, FNP-C, is a board-certified family nurse practitioner. She has experience in primary care and hospital medicine.

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Meaning of ambulatory in English

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• nonstationary
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ambulatory | Intermediate English

Examples of ambulatory, translations of ambulatory.

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Word of the Day

to change a document in order to deceive people

Sitting on the fence (Newspaper idioms)

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• HEDIS Measures and Technical Resources
• Adults’ Access to Preventive/Ambulatory Health Services

Adults’ Access to Preventive/Ambulatory Health Services (AAP)

The percentage of members 20 years and older who had an ambulatory or preventive care visit. The organization reports three separate percentages for each product line.

• Medicaid and Medicare members who had an ambulatory or preventive care visit during the measurement year.
• Commercial members who had an ambulatory or preventive care visit during the measurement year or the two years prior to the measurement year.

Why It Matters

This measure assesses whether adult health plan members had a preventive or ambulatory visit to their physician. Health care visits are an opportunity for individuals to receive preventive services and counseling on topics such as diet and exercise. These visits also can help them to address acute issues or manage chronic conditions.

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Ambulatory procedure visit.

32 CFR § 220.14

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of, relating to, or capable of walking: an ambulatory exploration of the countryside.

adapted for walking, as the limbs of many animals.

moving about or from place to place; not stationary: an ambulatory tribe.

Also ambulant . Medicine/Medical .

not confined to bed; able or strong enough to walk: an ambulatory patient.

serving patients who are able to walk: an ambulatory care center.

Law . not fixed; alterable or revocable: ambulatory will.

Also called deambulatory . Architecture .

an aisle surrounding the end of the choir or chancel of a church.

the covered walk of a cloister.

Origin of ambulatory

Other words from ambulatory.

• am·bu·la·to·ri·ly, adverb
• non·am·bu·la·to·ry, adjective, noun, plural non·am·bu·la·to·ries.

Words Nearby ambulatory

• ambulance stocks
• ambulatory care

Dictionary.com Unabridged Based on the Random House Unabridged Dictionary, © Random House, Inc. 2024

How to use ambulatory in a sentence

That feeling passed and the child grew into an ambulatory creature whose artifacts Irvin used to print cyanotypes.

A procedure after 16 weeks must be done at a hospital or ambulatory surgical center.

This kind of self-balancing is something that humans do unconsciously and continuously but it must be built and programmed in to an ambulatory robot.

Now, they hope to take more serious cases, including older, less ambulatory people.

“Our algorithm, that the ethicists, infectious disease experts worked on for weeks … clearly didn’t work right,” Tim Morrison, the director of the ambulatory care team, told residents at the event in a video posted online.

The majority of the school-aged students are nonverbal and not fully ambulatory .

The firefighters did not want the ambulatory passengers to chance onto an electrified rail or encounter some other hazard.

Already the clinic will incur extra cost to gain an ambulatory -surgery-facility license.

Piscitelli found out just how bad it had been when he counted the number of ambulatory survivors who came back with the dawn.

If it's dead, it's undead, like the culture at large: ambulatory in the age of Twilight.

This was entered by two arches, which may still be seen leading out of the ambulatory .

Further to the east, as we shall find in due course, may be seen the low vaulted retro-choir or ambulatory of one bay.

The four embryonic post- ambulatory appendages are now at the height of their development.

The full number of joints are not at once reached, but in the ambulatory appendages five only appear at first to be formed.

All the ambulatory feet and the very small left hand fold beneath, leaving only the flat surface of one hand exposed to view.

British Dictionary definitions for ambulatory

/ ( ˈæmbjʊlətərɪ ) /

of, relating to, or designed for walking

changing position; not fixed

Also: ambulant able to walk

law (esp of a will) capable of being altered or revoked

an aisle running around the east end of a church, esp one that passes behind the sanctuary

a place for walking, such as an aisle or a cloister

Collins English Dictionary - Complete & Unabridged 2012 Digital Edition © William Collins Sons & Co. Ltd. 1979, 1986 © HarperCollins Publishers 1998, 2000, 2003, 2005, 2006, 2007, 2009, 2012

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• v.32(2); 2017 Feb

Healthcare Fragmentation and the Frequency of Radiology and Other Diagnostic Tests: A Cross-Sectional Study

Lisa m. kern.

1 Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY USA

2 Division of Health Policy and Economics, Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, NY USA

Joanna K. Seirup

Lawrence p. casalino, monika m. safford.

Fragmented ambulatory care has been associated with high rates of emergency department visits and hospitalizations, but effects on other types of utilization are unclear.

To determine whether more fragmented care is associated with more radiology and other diagnostic tests, compared to less fragmented care.

We conducted a cross-sectional study using claims from five commercial payers for 2010. The study took place in the Hudson Valley, a seven-county region in New York State.

Participants

We included adult patients who were insured through the participating payers and were attributed to a primary care physician in the region. We restricted the cohort to those with ≥4 ambulatory visits, as measures of fragmentation are not reliable if based on ≤3 visits ( N = 126,801).

Main Measures

For each patient, we calculated fragmentation using a reversed Bice-Boxerman Index, which we divided into seven categories. We used negative binomial regression to determine the association between fragmentation category and rates of radiology and other diagnostic tests, stratified by number of chronic conditions and adjusting for patient age, gender, and number of visits.

Key Results

Patients with the most fragmented care had approximately twice as many radiology and other diagnostic tests as patients with the least fragmented care, across all groups stratified by number of chronic conditions (each adjusted p  < 0.0001). For example, among patients with ≥5 chronic conditions, those with the least fragmented care had 258 tests per 100 patients, and those with the most fragmented care had 542 tests per 100 patients (+284 tests per 100 patients, or +110 %, adjusted p  < 0.0001).

More fragmented care was independently associated with higher rates of radiology and other diagnostic tests than less fragmented care.

INTRODUCTION

Patients with chronic disease often see a multitude of outpatient providers. For example, Medicare beneficiaries see a median of seven physicians in four different practices each year. 1 Although seeing more than one physician may be clinically appropriate, and may be necessary to achieve recommended care, this dispersion of care creates a challenge. The typical primary care physician has 229 other physicians in 117 practices with whom to coordinate care—for their Medicare beneficiaries alone. 2 Communication across physicians caring for the same patient is often inconsistent and incomplete, with relevant clinical information missing in one of every seven primary care visits. 3

Fragmentation of ambulatory care has been associated with higher rates of avoidable emergency department visits and hospitalizations, higher costs, and lower patient satisfaction. 4 – 7 The relationship between fragmentation of care and other types of utilization, such as radiology and other diagnostic tests, has not been well studied. Previous studies have also not fully explored the relationship between fragmentation and chronic disease. This is important, because the number of chronic conditions may serve as a potential confounder in the relationship between fragmentation and subsequent outcomes.

We sought to determine the association between fragmentation and the frequency of radiology and other diagnostic tests, with the hypothesis that more fragmentation would be associated with more testing. We specifically sought to determine how such an association might vary with the number of chronic conditions. This question has implications for patients, providers, and policy makers alike, in part because provider reimbursement is shifting from fee-for-service to value-based payments, which makes providers increasingly responsible for all the care that their patients receive (not just care that they themselves provide). 8

We conducted a cross-sectional study of commercially insured adults who were attributed to primary care physicians in the Hudson Valley region of New York in 2010. We determined associations between healthcare fragmentation and the frequency of radiology and other diagnostic tests, stratifying patients by their numbers of chronic conditions and adjusting for other potential confounders. Institutional review boards at Weill Cornell Medical College and Kingston Hospital approved the protocol.

The Hudson Valley consists of 7 counties (Dutchess, Orange, Putnam, Rockland, Sullivan, Ulster, and Westchester) north of New York City. Approximately 85 % of people in this region live in urban or suburban areas. 9 At the time of the study, most physicians in the region were in small- and medium-sized private practices (≤25 physicians per practice) 10 and accepted insurance from multiple payers, with fee-for-service as the dominant model of payment.

We included adults (≥18 years old) who had commercial health insurance through one of five participating plans, which together insured approximately 60 % of the region’s commercially insured population (Aetna, Capital District Physicians’ Health Plan, Hudson Health Plan, MVP Health Care, and UnitedHealthcare). These plans were convened by the Taconic Health Information Network and Community (THINC), a community-based organization that is now part of HealthlinkNY. 11

Data Source

A third-party company had aggregated claims across payers and attributed patients to primary care physicians in the Hudson Valley, using previously specified logic. 12 The data set included all claims for 2010 for the attributed patients, regardless of the rendering provider. Variables included patient study ID, patient age, patient gender, date of service, rendering provider study ID, Current Procedural Terminology (CPT) codes, and International Classification of Diseases–Ninth Revision (ICD-9) codes. The data set also included patient-level counts of outpatient radiology and other diagnostic tests, which had been derived by the data aggregator through proprietary algorithms in the context of a broader project that attempted to place all utilization into eight categories, with outpatient radiology and other diagnostic tests being one category. 13 “Other diagnostic tests” included outpatient diagnostic tests that were assisted by imaging but may not have been performed by a radiologist per se, such as cardiac catheterization. This category excluded laboratory tests, such as blood and urine tests.

We identified ambulatory visits with CPT codes using a modified version of the definition by the National Committee for Quality Assurance. 14 Modifications restricted the definition to evaluation-and-management visits for adults that would take place in an office setting, excluding management-only visits (e.g., dialysis, chemotherapy, and physical therapy) and excluding non-office-based visits (e.g., home visits and visits in nursing facilities). This definition also excluded emergency department visits.

We used ICD-9 codes to calculate the total number of chronic conditions for each patient, using the 27 chronic conditions defined by the Centers for Medicare and Medicaid Services Chronic Condition Warehouse. 15 We combined two dementia categories into one to avoid double-counting, yielding 26 unique categories.

We calculated a fragmentation score for each patient based on the Bice-Boxerman Index ( Appendix ). 16 This index was originally labeled as a measure of “continuity,” but—as its originators intended—it actually measures more than consistency of care with a single provider. The index captures both “dispersion” (the spread of a patient’s care across multiple providers) 17 and “density” (the relative share of visits by each provider) 17 . This index has been used previously to predict emergency department visits, hospitalizations, and costs of care. 4 The Bice-Boxerman Index has been found to be highly correlated with other measures of continuity or fragmentation, such as the Herfindahl-Hirschman Index, the Usual Provider of Care Index, and the Sequential Continuity Index. 18

Values of the original Bice-Boxerman Index range from 0 (least continuity, or most fragmentation) to 1 (most continuity, or least fragmentation). Patients receive a raw score of 0 if each ambulatory visit is with a different provider and a raw score of 1 if all visits are with the same provider. Other patterns of visits and providers receive intermediate scores; patterns with high dispersion (many providers) and low density (a relatively low proportion of visits by each provider) receive worse scores (indicating more fragmentation) than patterns with low dispersion and high density. To facilitate interpretation, we reversed the scores (calculating 1 minus the Bice-Boxerman Index score), so that higher values reflected more fragmentation. For the remainder of the paper, we refer to these transformed scores simply as scores.

The theoretical distribution of the Bice-Boxerman Index is skewed rather than normal, because the number of possible patterns that reflect fragmented care are more numerous than the number of possible patterns that reflect continuous care. Thus, we did not treat the index as a continuous variable; instead, we created seven categories of fragmentation scores. Scores of 0.00 (least fragmentation) were placed in category 1, scores of 1.00 (most fragmentation) were placed in category 7, and the scores in between were divided into quintiles (categories 2–6). We chose quintiles because they provided a more detailed view than tertiles or quartiles, while still being a manageable number of categories for interpretation.

Statistical Analysis

We excluded patients if all claims for ambulatory visits had missing providers (<0.5 % of the cohort). We also excluded patients who had outlier observations (>99.9th percentile) for the number of ambulatory visits or providers, as some of those observations appeared to be erroneous. We used descriptive statistics to characterize patients and ambulatory visits.

We restricted the cohort to patients with ≥4 ambulatory visits, because measures of fragmentation may not be reliable if based on ≤3 visits. 6 We had complete data on patient characteristics and visit patterns for >99.9 % of the patients in this cohort. We stratified patients by fragmentation category and summarized utilization of ambulatory visits within category. We reported unadjusted mean counts of radiology and other diagnostic tests per 100 patients, stratified by fragmentation category and by the number of chronic conditions (0, 1–2, 3–4, ≥5). To determine adjusted rates of radiology and other diagnostic tests, we used the exponentiated least squares means by fragmentation category from generalized linear models with a negative binomial distribution. This approach was chosen because the data were non-negative and over-dispersed. Models were stratified by chronic condition group and adjusted for age, gender, and number of ambulatory visits.

Statistical analyses were conducted with SAS statistical software (version 9.4; SAS Institute Inc., Cary, NC).

Study sample

In 2010, there were 190,223 adults in the Hudson Valley who were insured by a participating health plan, were attributed to a primary care physician, and had ≥1 claim (Fig.  1 ). Of those, 189,429 (99.6 %) had ≥1 ambulatory visit with a non-missing rendering provider. We excluded 288 adults (0.2 %) with outlier observations for visits or providers, leaving 189,141 patients. Of those, 62,340 (33 %) had ≤3 visits, and 126,801 (67 %) had ≥4 ambulatory visits.

Derivation of the study sample.

Patient characteristics

Patients with ≤3 visits had a mean age of 41.8 years, fewer than half (47.5 %) were female, and they had a median of 0 chronic conditions (Table  1 ).

Characteristics of Patients and Their Ambulatory Visits over a One-Year Period

*Only those patients with ≥4 visits were included in the subsequent analyses. p values are based on t tests for continuous variables and chi-square tests for categorical variables. Missing data: gender ( N  = 29), number of chronic conditions ( N  = 22)

Patients with ≥4 visits were included in subsequent analyses. They were older, with a mean age of 51.2 years (Table  1 ). More than 75 % were younger than age 65; the maximum age was >100 years. More than half were female (61.8 %). The median number of chronic conditions was two. The distribution of the number of chronic conditions was as follows: 18 % of patients had zero chronic conditions, 35 % had one or two, 28 % had three or four, and 19 % had five or more. Patients had a median of eight ambulatory visits (range 4 to 56), with a median of four unique providers (range 1 to 17). The typical patient had 44 % of visits with the most frequently seen provider (range 9 % to 100 %).

Healthcare fragmentation

Fragmentation scores were not determined exclusively by the number of visits (Table  2 ). Patients with more fragmented care generally saw more providers than patients with less fragmented care. Patients with more fragmented care had a lower proportion of their visits with the most frequently seen provider than patients with less fragmented care.

Dividing Patients with Four or More Visits into Seven Groups, Based on the Extent of Healthcare Fragmentation

*These categories were derived from Bice-Boxerman Index scores that had been reversed (equal to 1 minus the raw Bice-Boxerman score). Patients with reversed scores of 0.00 were placed into category 1, patients with reversed scores of 1.00 were placed into category 7, and patients with reversed scores of 0.01 to 0.99 were divided into quintiles

IQR = interquartile range

Healthcare fragmentation and radiology utilization

As fragmentation increased, utilization of radiology and other diagnostic tests also increased, adjusting for patient age, gender, and number of ambulatory visits (Fig.  2 ). This association was observed within each stratum of chronic conditions. Patients with the most fragmented care had approximately twice as many radiology and other diagnostic tests as patients with the least fragmented care, regardless of their number of chronic diseases. Because patients with a greater number of chronic conditions tended to have more radiology and other diagnostic tests than patients with fewer chronic conditions, a doubling of the number of tests had the largest absolute effect for those with the most chronic conditions.

Adjusted mean number of radiology and other diagnostic tests per 100 patients, stratified by fragmentation category and by number of chronic conditions. Note: This analysis is among those patients with ≥4 visits. Fragmentation categories were derived from Bice-Boxerman Index scores that had been reversed (equal to 1 minus the raw Bice-Boxerman score) and divided into seven groups, as described in Table  2 . Adjusted means were derived from negative binomial regression models, adjusted for patient age, gender, and number of visits.

For example, in adjusted analyses, patients with 0 chronic conditions and the least fragmented care used 71 tests per 100 patients (Fig.  2 ). Patients with 0 chronic conditions and the most fragmented care used 139 tests per 100 patients, equivalent to an absolute difference of 68 tests per 100 patients, or a relative increase of +95 % for category 7 vs. category 1 (adjusted p  < 0.0001). Patients with ≥ 5 chronic conditions used 258 tests per 100 patients if they had the least fragmented care and 542 tests per 100 patients if they had the most fragmented care (+284 tests per 100 patients, +110 %, adjusted p  < 0.0001).

In this study of commercially insured adults, patients with the most fragmented care had twice as many radiology and other diagnostic tests as patients with the least fragmented care, regardless of the number of chronic conditions. Because patients with more chronic conditions had more tests than those with fewer chronic conditions, a doubling of the number of tests had the largest absolute effect for those with the most chronic conditions. These associations were observed adjusting for patient age, gender, and number of ambulatory visits.

We are aware of only two other studies that have explored the effect of fragmentation on radiology testing. In one study of Medicare beneficiaries, seeing a greater number of physicians in the year following a stroke was associated with a higher likelihood of having ≥4 computerized tomography (CT) scans of the head that year, compared to seeing fewer physicians. 19 That study was limited by its ecologic design, with the numbers of physicians and CT scans calculated at the level of the hospital referral region rather than the patient level. Another study considered the relationship between fragmentation and rates of use for 19 “potentially overused” procedures among Medicare beneficiaries. 20 Greater fragmentation was associated with more testing for five of eight radiology tests considered. 20 That study adjusted for the number of chronic diseases rather than stratify by number of chronic diseases.

The rates of testing we observed were somewhat higher than rates of testing observed elsewhere, although few such studies are available for comparison. A study in Group Health in Seattle, WA, found that, on average, between 2000 and 2006, patients aged 45–54 years had approximately 1400 diagnostic imaging tests per 1000 enrollees per year, and patients aged 55–64 years had approximately 1900 diagnostic imaging tests per 1000 enrollees per year. 21 That study confirms that having multiple tests per patient per year is common; however, it did not restrict its cohort to those with ≥4 visits per year and did not stratify by the number of chronic conditions, thereby precluding precise comparisons. Another study, in six integrated health systems across the country, found that rates of diagnostic medical imaging increased nearly every year from 1996 to 2010, 22 suggesting that the rates of testing observed in the first study above would be even higher in 2010, the year corresponding to our study.

Our study adds to the literature in several ways. First, it extends observations of fragmentation—most of which have been made previously in Medicare populations—to a younger, commercially insured population. This is relevant, because patterns of care that patients become accustomed to as adults (ages 18 to 64 years) may contribute to the patterns of care that they seek out as older adults (ages 65 years and older). Second, this study uses stratification to separate the effect of chronic conditions from the effect of fragmentation. Previous studies have typically either considered patients with a specific disease (such as diabetes) 4 , 5 or considered all patients together. 6 Third, this study does not treat fragmentation as a continuous variable; rather, it recognizes that it is more common for patients to have fragmented care than not, and it uses categories of scores to improve detection of trends.

One mechanism by which fragmented care may lead to more utilization is through providers’ lack of access to results of previous radiology tests that may have been ordered by other providers caring for the same patient. If providers cannot access previous results, they may repeat tests. Our study’s findings are consistent with this hypothesis, although we did not have detailed information on physician decision making. A previous study found that if physicians accessed radiology test results through an electronic health information exchange, the adjusted odds of repeat testing within 90 days of the original test decreased by 25 % compared to the odds of testing when results were available but not accessed. 23

This study has several limitations. First, it is cross-sectional and cannot prove causality. Second, the study does not capture the appropriateness of the tests ordered. It is possible that the tests are medically appropriate and not duplicative or unnecessary. For example, some additional testing may occur when patients seek second opinions, which might be appropriate, and which we cannot capture. Because our study does not measure clinical outcomes, we cannot determine whether the additional radiology tests in the groups with more fragmented care had any clinical benefit or harm. Third, although we stratified by chronic conditions, unmeasured differences in severity of illness across subgroups may persist. Other unmeasured confounders may also be present. Fourth, this study took place in one region. This region may be different from other regions of the country, but it may also be similar to other communities with physicians in predominantly small and medium-sized practices accepting multiple types of insurance.

Results from this study raise additional questions that could be explored in future studies, such as how fragmentation affects specific types of radiology tests, how the distribution of visits between generalists and specialists affects the frequency of testing, whether the association between fragmentation and testing varies with particular chronic conditions, and whether the association between fragmentation and testing varies with particular types of health insurance products.

If at least some of the testing that occurs in the context of highly fragmented care represents overuse, then the results of this study suggest that many patients are being exposed to unnecessary radiation, other potential side effects of the tests (such as renal toxicity from contrast dye), and the risk of downstream testing to investigate incidental findings. The cost to patients of a given radiology test varies widely, depending on the provider and the payer; for example, the cost of a single magnetic resonance imaging test can range from approximately $600 to more than $5000 (not including the cost of the radiologist’s reading of the image). 24 Thus, the potential impact of a twofold difference in radiology utilization could be substantial.

The findings of this study are important for both providers and policymakers, because physician reimbursement is changing. In accountable care organizations and other types of alternative payment models, providers take clinical and financial responsibility for all of a patient’s care, even care provided by others. 8 The Centers for Medicare and Medicaid Services has set a goal of having 50 % of Medicare payments tied to quality or value through alternative payments by the end of 2018, up from essentially 0 % of payments in 2012. 8 To this end, value-based payments are a central feature of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). 25

In conclusion, greater fragmentation of care was associated with higher utilization of radiology and other diagnostic tests. Patients with the most fragmented care had approximately twice as many radiology and other diagnostic tests as patients with the least fragmented care, regardless of the number of chronic conditions, and independent of the number of ambulatory visits. Because patients with more chronic conditions had more tests than patients with fewer chronic conditions, fragmentation had the greatest absolute effect for patients with the most (≥5) chronic conditions. This suggests that diffuse patterns of care may result in excess testing and avoidable costs. In an era when efficient use of healthcare resources is valued, fragmentation of care may represent an under-recognized source of inefficiency.

Acknowledgments

The authors gratefully acknowledge Susan Stuard, MBA, of HealthlinkNY for facilitating access to the data and for encouraging this evaluation. The authors also thank Phyllis Johnson, MBA, for her assistance with data management.

Appendix. Formula for the Original Bice-Boxerman Index (BBI)* 16

where n = total number of visits in the 12-month period, n i = number of visits to provider i , and p = total number of providers

* Note that we used a modified Bice-Boxerman Index (reversed and divided into 7 categories), as described in the “ Methods ” section.

Compliance with Ethical Standards

Institutional review boards at Weill Cornell Medical College and Kingston Hospital approved the protocol.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

This study was funded by the Commonwealth Fund (grant #20140960), which supported efforts by Dr. Kern and Ms. Seirup. The funding source had no role in the study design, conduct, or reporting. Dr. Kern and Ms. Seirup had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Presentations

This work was presented at the national meeting of the Society of General Internal Medicine on May 13, 2016.

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Title: hallucination detection in foundation models for decision-making: a flexible definition and review of the state of the art.

Abstract: Autonomous systems are soon to be ubiquitous, from manufacturing autonomy to agricultural field robots, and from health care assistants to the entertainment industry. The majority of these systems are developed with modular sub-components for decision-making, planning, and control that may be hand-engineered or learning-based. While these existing approaches have been shown to perform well under the situations they were specifically designed for, they can perform especially poorly in rare, out-of-distribution scenarios that will undoubtedly arise at test-time. The rise of foundation models trained on multiple tasks with impressively large datasets from a variety of fields has led researchers to believe that these models may provide common sense reasoning that existing planners are missing. Researchers posit that this common sense reasoning will bridge the gap between algorithm development and deployment to out-of-distribution tasks, like how humans adapt to unexpected scenarios. Large language models have already penetrated the robotics and autonomous systems domains as researchers are scrambling to showcase their potential use cases in deployment. While this application direction is very promising empirically, foundation models are known to hallucinate and generate decisions that may sound reasonable, but are in fact poor. We argue there is a need to step back and simultaneously design systems that can quantify the certainty of a model's decision, and detect when it may be hallucinating. In this work, we discuss the current use cases of foundation models for decision-making tasks, provide a general definition for hallucinations with examples, discuss existing approaches to hallucination detection and mitigation with a focus on decision problems, and explore areas for further research in this exciting field.

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Concept: Ambulatory Visits

Concept description.

Last Updated : 2020-02-18 Last Reviewed : 2006-11-14 -->

Introduction

Definition of ambulatory visits.

Ambulatory Visits can be extracted from the Medical Services (Physician Claims) data. The Hospital Abstracts data are also used to identify physician services that are provided to patients who are admitted to acute care hospitals, so these inpatient visits are not included as ambulatory visits. The specific type of physician service provided during an ambulatory visit is defined by a 4-digit tariff code recorded in the Medical Services data. For a sample of some of the tariff codes, please see the MCHP Documentation - tariff_serv_type.txt document in the LINKS section below.

Reason For Change in Methodology

Method of identifying ambulatory visits - physician.

• Include only those records with the tariff prefix, PREFIX = "7". These are defined as "Visits, Calls and Special Tests" in the Medical Services data.

001 - major /initial, 002 - other consultations, 003 - complete exam - initial, 004 - complete exam - other, 005 - partial / minor / subsequent visit, 006 - regional history & visit, 007 - intermediate visit, 008 - psychotherapy, 009, 010, and 011 - currently these values are not defined in the MGC group of codes, but fall within the category of "Office Visits", and 012 - other office visits

013 - hospital visits - unassigned patient, 016 - hospital visit - chronic / palliative care, and 075 - obstetrical services - prenatal & postnatal visits.

• Exclude a visit if it happens during an inpatient hospital stay, identified using the hospital abstracts data. A visit on the day of admission or discharge, or in between these two dates is excluded.

"053" - E.E.N.T - optometry, "200" - Primary Care Nurse, "201" - Midwife, "99" - Unspecified or unknown "113" - Emergency Medicine

• Exclude Emergency Room services using the variable OPD with the following value: "E" - Emergency Room Services.
• Exclude Out of Province (OOP) claims, identified by the 3rd character in MDBLOC = "9".
• Exclude diagnoses beginning with "A", "B", or "C", which are associated with chiropractic claims.

Methods of Identifying Provider Types

• Ambulatory Visits - Physician – see above

12 - Physical Medicine & Rehab, 129 - Physical Medicine - OOP, 130 - Internal Medicine - Career Medical Scientist, 131 - Internal Medicine - Endocrinology, 132 - Internal Medicine - Haematology, 133 - Internal Medicine - Infectious Disease, 134 - Internal Medicine - Respiratory, 141 - Surgery - Vascular, 142 - Surgery - Thoracic, 143 - Surgery - Paediatric General, 15 - Oncology, 150 - Oncology - Medical, 151 - Oncology - Gynaecological, 152 - Oncology - Urological, 153 - Oncology - Paediatric, 154 - Oncology - Community, 155 - Oncology - ?, 156 - Oncology - ?, 158 - Oncology - Radiology

• Excluded Visits to primary care providers, pathologists and radiologists. Sources: Ambulatory Specialist Visits from Katz et al. (2019) deliverable and Technical Definitions of Indicators and Drug Codes from online supplement material from Katz et al. (2019).

11 - General Practice, 111 - General Practice – Metro Winnipeg/Brandon, 112 - General Practice – Rural, 200 - Primary Care Nurse

SAS Macro for Identifying Ambulatory Visits

Variation in the "ambulatory visits" definition.

• In some research, ambulatory visits include emergency room visits (where data are recorded) and contact in northern/remote nursing stations. In our current method, emergency room visits have been excluded from the definition.
• In past research, prenatal care visits were typically excluded from the definition because of tariff coding issues (e.g.: global billing and not being able to identify the exact number of visits). However, specific prenatal and postnatal care visit tariff codes were introduced in February 2000, and the current ambulatory visits definition now includes prenatal and postnatal visits.
• In some research, additional exclusions are made depending on the focus of the study. For example, in Katz et al. (2013), they excluded services provided to patients admitted to personal care homes (PCH) and emergency departments, as well as visits to specialist physicians in pediatrics, radiology, pathology and anaesthesiology.
• In some research, ambulatory visits has defined provider types. For more information, see Ambulatory Visits - Primary Care Provider / Ambulatory Primary Care Visits and Ambulatory Visits to Specialists/ Ambulatory Specialist Visits .

Other Notes

• Consultations that occur in an outpatient setting are considered ambulatory visits.
• For ambulatory visits that occur in a Personal Care Home (PCH), a note is written to the net_med SAS macro log file that identifies that there are ambulatory visits in a PCH setting. PCHs can be identified by the following range of values (500 - 699) in the HOSP variable in the Medical Services data.
• Nurse Practitioners started being recorded in Medical Services Data in 2005.

Related concepts  

• Health Status Indicators
• Manitoba Health Insurance Registry / MCHP Research Registry - Overview
• Mental Disorder / Mental Health Disorder / Mental Health Illness Classification
• Patient Characteristics
• Physician / Hospital Claims
• Physician Consultation Visits
• Prenatal Care Visits (PCV) / Prenatal Care (PNC) Visits
• Service Types, Physician Visits
• Undercounting Hospital Visits

Related terms  

• Ambulatory Visit Rates
• Ambulatory Visits - Physician
• Ambulatory Visits - Primary Care Provider / Ambulatory Primary Care Visits
• Ambulatory Visits by Age and Sex
• Ambulatory Visits to Specialists / Ambulatory Specialist Visits
• Family Physician (FP) / Family Physicians
• Hospital Abstracts Data
• Location of Ambulatory Visits
• Location of Visits to Physicians / Primary Care Providers
• Location of Visits to Specialists
• Medical Services / Medical Claims Data
• Special Call Claims
• Specialist Physicians (SP)

Links  

• MCHP Documentation - tariff_serv_type.txt

References  

• Brownell MD, Roos NP, Burchill C. Monitoring the impact of hospital downsizing on access to care and quality of care. Med Care 1999;37 (6 Suppl):135-150. [ Abstract ] ( View )
• Frohlich N, Markesteyn T, Roos NP, Carriere KC, Black C, De Coster C, Burchill CA, MacWilliam L. A Report on the Health Status, Socio-Economic Risk and Health Care Use of the Manitoba Population, 1992-93 and Overview of the 1990-91 to 1992-93 Findings . Winnipeg, MB: Manitoba Centre for Health Policy and Evaluation, 1994. [ Report ] [ Summary ] ( View )
• Frohlich N, Markesteyn T, Roos NP, Carriere KC, Black CD, De Coster C, Burchill CA, MacWilliam L. Stability and trends over 3 years of data. Med Care 1995;33(12 Suppl):DS100-DS108. [ Abstract ] ( View )
• Harrison ML, Graff LA, Roos NP, Brownell MD. Discharging patients earlier from hospital: Does it adversely affect quality of care? Canadian Medical Association Journal 1995;153(6):299-300. [ Abstract ] ( View )
• Harrison ML, Graff LA, Roos NP, Brownell MD. Discharging patients earlier from Winnipeg hospitals: does it adversely affect quality of care? CMAJ 1995;153(6):745-751. [ Abstract ] ( View )
• Kasian P, De Coster C, Peterson S, Carriere KC. Assessing the extent to which hospitals are used for acute care purposes. Med Care 1999;37 (6 Suppl):66-151.( View )
• Katz A, Chateau D, Bogdanovic B, Taylor C, McGowan K-L, Rajotte L, Dziadek J. Physician Integrated Network: A Second Look . Winnipeg, MB: Manitoba Centre for Health Policy, 2014. [ Report ] [ Summary ] [ Updates and Errata ] ( View )
• Katz A, Avery Kinew K, Star L, Taylor C, Koseva I, Lavoie J, Burchill C, Urquia M, Basham A, Rajotte L, Ramayanam V, Jarmasz J, Burchill S. The Health Status of and Access to Healthcare by Registered First Nation Peoples in Manitoba . Winnipeg, MB: Manitoba Centre for Health Policy, 2019. [ Report ] [ Summary ] [ Updates and Errata ] [ Additional Materials ] ( View )
• Katz A, Martens P, Chateau D, Bogdanovic B, Koseva I, McDougall C, Boriskewich E. Understanding the Health System Use of Ambulatory Care Patients . Winnipeg, MB: Manitoba Centre for Health Policy, 2013. [ Report ] [ Summary ] ( View )
• Manitoba Centre for Health Policy and Evaluation (1995). Summary: The Population Health Information System: Manitoba April 1990 - March 1993 .( View )
• Mustard CA, Kozyrskyj AL, Barer ML, Sheps S. Emergency department use as a component of total ambulatory care: a population perspective. CMAJ 1998;158(1):49-55. [ Abstract ] ( View )
• Mustard CA, Frohlich N. Socioeconomic status and the health of the population. Med Care 1995;33(12 Suppl):DS43-DS54. [ Abstract ] ( View )
• Roos NP, Shapiro E. Monitoring the Winnipeg Hospital System: The First Report. 1990-1992 . Winnipeg, MB: Manitoba Centre for Health Policy and Evaluation, 1994. [ Report ] [ Summary ] ( View )
• Roos NP, Fransoo R, Bogdanovic B, Carriere KC, Frohlich N, Friesen D, Patton D, Wall R. Needs-based planning for generalist physicians. Med Care 1999;37(6 Suppl):JS206-JS228. [ Abstract ] ( View )
• Roos NP, Burchill CA, Black CD. Utilization of hospital resources. Med Care 1995;33 (12 Suppl):55-72. [ Abstract ] ( View )
• Tataryn DJ, Mustard CA, Derksen S. The Utilization of Medical Services for Mental Health Disorders, Manitoba: 1991 - 1992 . Winnipeg, MB: Manitoba Centre for Health Policy and Evaluation, 1994. [ Report ] [ Summary ] ( View )
• Tataryn DJ, Roos NP, Black CD. Utilization of physician resources for ambulatory care. Med Care 1995;33(12 Suppl):DS84-DS99. [ Abstract ] ( View )
• Tataryn DJ, Roos NP, Black C. Utilization of Physician Resources. Volume I: Key Findings . Winnipeg, MB: Manitoba Centre for Health Policy and Evaluation, 1994. [ Report ] ( View )
• Tataryn DJ, Roos NP, Black C. Utilization of Physician Resources. Volume II: Methods and Tables . Winnipeg, MB: Manitoba Centre for Health Policy and Evaluation, 1994. [ Report ] ( View )

Keywords  

• ambulatory care
• Health Measures
• primary care