title: Exploring the impact of the physical environment on patient outcomes in ambulatory care settings.
abstract: OBJECTIVE
  This report of empirical literature on ambulatory care centers (ACCs) addresses a gap in the healthcare field by exploring physical features of ACC settings that have been associated with favorable patient outcomes.
  
  
  BACKGROUND
  Growing numbers of ACCs correspond with an increasing shift from inpatient to outpatient services. As the focus of ACCs shifts from treating episodes of illnesses to comprehensive, longitudinal, patient-centered care, different types of ACC settings seek to accommodate a variety of patient groups from different demographics.
  
  
  METHODS
  Given the range of ACC settings and population types and the paucity of literature focused on any one of these settings, the literature search process was broad based to include not only peer-reviewed literature, but also "gray literature" on ACC design. The primary focus was on research studies and reports that centered on some aspect of the physical environment in ACCs and their relationship to outcomes in these settings.
  
  
  RESULTS
  The following patient outcomes were identified in different phases of ACC patient experience: improved access and wayfinding, enhanced waiting experience, enhanced privacy, enhanced physician/staff-patient communication, reduced patient anxiety, and reduced risk of infection.
  
  
  CONCLUSIONS
  This article identifies physical design features of ACCs that can promote favorable patient outcomes. However, most literature reviewed adheres to a physician-centered model of episodic illness in which care ends with the experience in the exam room of the ACC. A more patient-centered approach has not been explored fully in the literature. The results indicate that there are many opportunities for future inquiry.
authors.affiliation: University of Northern Iowa, Cedar Falls, IA 50614-0332, USA. betrabet@uni.edu
authors.forename: Gowri Betrabet
authors.initials: GB
authors.lastname: Gulwadi
authors.forename: Anjali
authors.initials: A
authors.lastname: Joseph
authors.forename: Amy Beth
authors.initials: AB
authors.lastname: Keller
mesh_terms: D000554:Ambulatory Care Facilities; D006272:Health Facility Environment; D006801:Humans; D017063:Outcome Assessment, Health Care; D014481:United States