Approaches to reduce risk to patients in U.S. ambulatory health care

Ambulatory health care is complex, and the scope of practice has increased over the past several decades. In parallel, the National Academies report, Building a Better Delivery System: A New Engineering/Health Care Partnership, has gained the interest of health care professionals. Use of risk assessments is increasing. Although ambulatory care may be technologically less complex than inpatient care and seemingly less complex than other industries, it is logistically more complex. This increases the risk of potential harm to patients. These factors are substantially influenced not only by the structure of the primary care, but also by the supporting infrastructure and cohesion of the health care community at the regional level. This paper provides a summary of the major, risk-informed quality improvement strategies used in ambulatory care and discusses the community-level factors that positively influence the type and rigor of an ambulatory-level health care quality improvement.