Designing Safety-Net Clinics for Innovative Care Delivery Models

A number of trends inside and outside of health care are driving the development of innovative care delivery models. Rapidly increasing health care costs and insurance premiums have produced an expanding uninsured and underinsured population, as well as high utilization of emergency departments and greater use of community clinics. A persistent nurse shortage exacerbates the problems.

These factors, along with other changes in health care such as the rise of consumerism, have led to the development of new care delivery models. One such model is the patient-centered medical home, which provides comprehensive primary care by facilitating partnerships between patients, families, and personal physicians. Other innovative care delivery models emphasize the role of nurses and other non-physician health professionals in the whole spectrum of care.

Safety-net clinics deliver a range of primary and specialty care to medically underserved and uninsured people regardless of their ability to pay. As an important component of the health care system, safety-net clinics have been indispensable in fighting epidemic diseases and improving medical outcomes. Faced with a series of challenges (cuts in funding from federal, state, or local governments, increased numbers of patients, the credit crisis, etc.), safety-net clinics have consistently engaged with innovative care delivery models such as chronic disease management and service integration. They have also embraced new technologies, including telemedicine and mobile health units, to better serve target populations and reduce health care costs.

The design of the physical environment plays an important role in improving health care quality, work efficiency, and cost-effectiveness. Safety-net clinic design can have a substantial impact on the effectiveness of innovative care delivery models, but guidelines are limited. To contribute to a better understanding of the topic, this white paper seeks to identify key characteristics of the physical environment design for new care delivery models and to provide preliminary design recommendations.