Narrative
General Considerations
Future Trends:
Current Direction
As health care changes, the need for
During the last quarter century the
conveniently accessible clinics will grow.
provision of health care to veterans has
It is anticipated that in order to compete
changed dramatically.
When initially
with the private sector the VA will have to
developed, the care for veterans was
locate clinics close to where the veterans
episodic and inpatient oriented. Changes
live. This will result in more CBOC's in
in health care delivery have resulted in a
diverse areas away from the parent
shift of care to the outpatient arena with
facility. With the interdisciplinary nature
of primary care more of these clinics will
facilitate these changes the concept of
need to be established utilizing a variety
Community Based Outpatient Clinics
of
providers
including
physicians,
(CBOC) has been developed.
It is
physician assistants, nurse practitioners,
projected that with the coming of health
nurse clinical specialists, social workers
care reform (if not on a national level but
and others. It is anticipated that these
on a state by state level) the need for
clinics will provide the basics of care for
these clinics will increase.
the patient population that they are
following. More sophisticated testing and
A Community Based Outpatient Clinic is
consultations will be referred to the parent
a full time/part time ambulatory care
facility. An integral part of the concept of
facility that is physically separate, but
primary care is the provision for the
administratively attached to a VA Medical
biopsychosocial needs of the patient care
Center. The clinic is a simple physician's
and his/her family. The CBOC should be
office that provides primary care.
set up in a manner that will facilitate
Typically this care would consists of:
meeting this need.
Initial assessment of patient needs;
Potential developments in National Health
Acute and chronic basic care of
Care Reform may dictate that the VA will
biopsychosocial needs;
not only care for the veteran but also for
Health promotion and disease
her/his family. It is planned all veterans
prevention; and
will be able to utilize VA facilities under
Referral for other levels of care.
the new health care plan. The number of
veterans this could potentially involve is
Administratively the clinics would be
in excess of 26 million with more than 356
under
the
supervision
of
the
million visits per year.
ACOS/Ambulatory Care or the person
designated to be the supervisor of
primary care. Periodic visits from the
clinical and administrative chiefs at the
parent facility would be made to ensure
quality care was being delivered.
VA Design Guide
PAGE 2-1
Community Based Outpatient Clinic