Medical and Dental Space Planning

A Comprehensive Guide to Design, Equipment, and Clinical Procedures

Jain Malkin

• Editorial: Wiley
• Año: 2014
• ISBN:
  9781118896570
• Edición: 4
• Categoría: Architecture
• Categoría: Interior Design

THE UPDATED DEFINITIVE REFERENCE ON MEDICAL AND DENTAL OFFICE DESIGN

Medical and Dental Space Planning is an indispensable guide to the myriad of details that make a medical or dental practice efficient and productive. The unique needs of more than thirty specialties, as well as primary care, are explained in the context of new technology and the many regulatory and compliance issues influencing design. Concepts are also presented for ambulatory surgical centers, diagnostic imaging, clinical laboratories, breast care clinics, endoscopy centers, community health centers, radiation oncology, and single-specialty and multispecialty group practices and clinics. A thorough review of the latest dental technology and many creative space plans and design ideas for each dental specialty will be of interest to both dentists and design professionals. Important topics like infection control are top of mind, influencing every aspect of dental office design.

An "inside look" at what goes on in each specialist's office will familiarize readers with medical and dental procedures, how they are executed, and the types of equipment used. Technology has radically impacted medical and dental practice: digital radiography, electronic health records, mobile health devices, point-of-care diagnostic testing, digital diagnostic instrumentation, CAD/CAM systems for digital dental impressions and milling of restorations in the dentist's office, portable handheld X-ray, and 3D cone beam computed tomography for dentists all have major implications for facility design.

The influence of the Affordable Care Act is transforming primary care from volume-based to value-based, which has an impact on the design of facilities, resulting in team collaboration spaces, larger consultative examination/assessment rooms, and accommodation for multidisciplinary practitioners who proactively manage patient care, often in a patient-centered medical home context.

The wealth of information in this book is organized to make it easy to use and practical. Program tables accompany each medical and dental specialty to help the designer compute the number and sizes of required rooms and total square footage for each practice. This handy reference can be used during interviews for a "reality check" on a client's program or during space planning. Other features, for example, help untangle the web of compliance and code issues governing office-based surgery.

Illustrated with more than 600 photographs and drawings, Medical and Dental Space Planning is an essential tool for interior designers and architects as well as dentists, physicians, and practice management consultants.

Chapter 1
New Directions

Primary care is undergoing a radical transformation from physician-centered practices to team-based patient-centered care. Amid the upheaval, this is spawning real innovation as healthcare organizations across the nation challenge themselves to reduce waste and provide more effective care and—most important—to document and measure health outcomes with robust IT systems. States have some leeway in determining how they wish to handle newly insured Medicaid beneficiaries and even if they wish to participate at all in the state health insurance exchange program. If they do not, Medicaid enrollees will be eligible to join through an exchange created by the federal government. One thing is certain: This is a massive undertaking and the regulations are voluminous, the “shared savings” with Medicare and Medicaid—the incentive payments for meeting the targets—are complex beyond measure, and this bold experiment is going to provide a lot of work for analysts and financial consultants. But isn’t it great that people with preexisting conditions will now be able to buy insurance and the many Americans who are uninsured will now be able to buy a basic level of coverage?

When the dust settles from all the chaos, there should be huge benefits in the areas of patient safety, proactive coordination of care for those with chronic conditions, and reduced hospitalization and visits to the ED due to the focus on prevention. In theory, if patients have access to primary care, most of their conditions can be dealt with in a low-cost setting and in a timely manner, before they ramp up to requiring more expensive procedures. This will save money and reduce the escalation of healthcare expenditures. A thoughtful exploration of healthcare reform delving into specific (and often amusing) examples of the ineffectiveness of our current system will be of interest to anyone wondering about how we got to this point and how we can get better healthcare for half the cost.¹ The writing style makes it a page-turner as its author, Joe Flower, untangles the many forces that have resulted in our current system, but he ends with optimism.

ACO QUALITY METRICS

Accountable care organizations (ACOs) will be assessed by 65 quality metrics spanning five equally weighted domains: patient and caregiver experience, care coordination, patient safety, preventive health, and care for frail elderly and at-risk populations.²

A SAMPLING OF INNOVATION

Innovation occurs in small and large settings as can be seen in the examples below, starting with Oregon’s five-year Medicaid experiment to test whether coordinated care can deliver better health at lower cost. Next, a project at the Mayo Innovation Center looks at outpatient obstetrical care and better ways to provide continuity between scheduled visits. Last, a two-physician family practice takes bold steps to redesign care with a new office that is iconoclastic in its concept and aesthetically stunning as well.

Oregon’s Medicaid Transformation

The cover story in Modern Healthcare shouts “Kitzhaber’s Gamble: Oregon makes risky bet on fixed-budget ACOs to curb Medicaid costs.”³ A year into Oregon’s five-year plan, 16 Coordinated Care Organizations (CCOs) are caring for 90 percent of Medicaid beneficiaries using a patient-centered medical home model. CCOs receive per capita monthly payments for care delivered in this pilot program that is underwritten by $1.9 billion in federal funding from the Centers for Medicare & Medicaid Services (CMS). The provider organizations must include dental and mental healthcare and focus on chronic conditions, including addiction problems and mental illness. A principal goal is to transition from costly fee-for-service to a program that emphasizes primary and preventive care. This requires social workers, nurses, medical assistants, and physicians to work together to systematically keep track of complex patients to anticipate their needs and reach out to them for adjustments to medications and to get them to the clinic for preventive care. These are the patients who end up in the ER repeatedly if not closely managed.

Governor Kitzhaber negotiated a waiver with the CMS to get funding to kick off this initiative and, in return, the deal requires progress on 33 quality and access measures. The program is not without controversy from those who wonder if a capitated payment will cause providers to stint on care, and hospitals express concern that success will result in a reduction in admissions. This is a bold plan in the national spotlight. Several other states are proposing to follow Oregon’s lead, and only time will tell whether it is possible to get a handle on soaring healthcare costs and, at the same time, improve the health and well-being of Americans.

Mayo OB Nest: Redesigning Continuity of Care

A project undertaken at the Mayo Innovation Center was the study of outpatient OB care.⁴ They realized that the current schedule of appointments was based on a provider-centric sense of continuity that did not address what happens between visits, and this may even be more important to patients. Looking at ways to give mothers the opportunity to tap into their own knowledge base—to be able to validate their wisdom—led to experimentation with different options. Patients were given the ability to text a nurse, and to be able to Skype in for a patient visit. They were given portable Doppler devices to be able to listen to the baby’s heartbeat to help build the mother’s sense of confidence. This continual feedback loop is designed to reduce the bottleneck around the scheduled appointments and allow mothers to enjoy a sense of well-being, rather than stress.

Village Family Medicine

Breaking the mold for primary care practices led the two physicians who formed this practice to examine the patient encounter to see how they could improve the patient experience. To begin with, they have a same-day appointment policy and most visits are 30 minutes from arrival to checkout. As they worked with their architects to program the space, they realized that 85 percent of patients did not need to sit on an exam table during the visit. Instead, they developed assessment rooms (Figure 1-1) that serve for everything except minor procedures or disrobing. The following functions occur in this roo...