title: Where Americans get acute care: increasingly, it's not at their doctor's office.
abstract: Historically, general practitioners provided first-contact care in the United States. Today, however, only 42 percent of the 354 million annual visits for acute care--treatment for newly arising health problems--are made to patients' personal physicians. The rest are made to emergency departments (28 percent), specialists (20 percent), or outpatient departments (7 percent). Although fewer than 5 percent of doctors are emergency physicians, they handle a quarter of all acute care encounters and more than half of such visits by the uninsured. Health reform provisions in the Patient Protection and Affordable Care Act that advance patient-centered medical homes and accountable care organizations are intended to improve access to acute care. The challenge for reform will be to succeed in the current, complex acute care landscape.
authors.affiliation: Department of Emergency Medicine, School of Medicine, Emory University, Emory University Hospital Midtown, Atlanta, GA, USA. srpitts@emory.edu
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Pitts
authors.forename: Emily R
authors.initials: ER
authors.lastname: Carrier
authors.forename: Eugene C
authors.initials: EC
authors.lastname: Rich
authors.forename: Arthur L
authors.initials: AL
authors.lastname: Kellermann
mesh_terms: D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D058006:General Practice / Q000706:statistics & numerical data*; D018166:Health Care Reform; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D006801:Humans; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D018802:Patient-Centered Care; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data* / Q000639:trends; D011785:Quality Assurance, Health Care / Q000331:legislation & jurisprudence / Q000592:standards; D014481:United States