402 Exam 4 Flashcards
mange the health of populations served by the integrated systems
accountable care organizations (ACOs)
includes wellness and health promotion, illness prevention, acute and subacute care, chronic disease, rehabilitation, end of life care, care coordination, and community engagement
population management
measure performance
dashboard indicators
healthy people 2020 goals are to attain both quality of life and increase years of healthy life, achieve health equity and eliminate health disparities, and create social and physical environments as a ___ _____ for health care.
social mandate
care management strategies
utilization management
critical pathways
disease management
demand management
attempts to provide optimal use of services to redirect care and monitor the appropriate use of provider care/treatment services for both acute and community/ambulatory services.
utilization management
were initiated in the early 2000s.
are tools that specify activities providers may use in a timely sequence to achieve desired outcomes for care
critical pathways
constitutes systematic activities to coordinate health care interventions and communications for populations with disease conditions in which client self care efforts are significant
disease management
seeks to control use by providing clients with correct info and education strategies to make healthy choices, to use healthy and health-seeking behaviors to improve their health status and to make fewer demands on the health care system
demand management
one function of case management, is the deliberate organization of client care activities between two or more participants involved in a client’s care to facilitate the appropriate delivery of health care services
care coordination
provides accessible, continuous, coordinated, comprehensive care and is managed centrally by a physician/nurse practitioner with the active involvement of non-physician practice staff
Medical/Health Home or Patient/Client-Centered Medical Home model
bridge the gaps among diverse services, providers, and settings through the systematic application of evidence-based interventions that improve communication and transfer of information within and across services, enhancing post-acute care follow up, and decreasing gaps in care by the use of a single consistent provider
transitions of care
6 rights of case management
care time provider setting price/value outcomes
for this type of nurse, ample opportunity exists to apply and revise critical path/map care guidance prototypes for a target population experiencing acute and chronic health problems.
case manager
is another tool used in case management.
it assesses the current and future needs of a client for catastrophic or chronic disease over a life span
life care planning
nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and _____ in the care of individuals, families, communities, and populations.
advocacy
is composed of interactions that reflect 3 subprocesses: amplifying, clarifying, and verifying.
information exchange process
occurs between the nurse and the client to assess the needs and demands that will eventually frame the client’s decision
amplifying
is a process in which the nurse and client strive to understand meanings in a common way
clarifying
is the process used by the nurse advocate to establish accuracy and reality in the informing process
verifying
involves upholding a client’s right to make a choice and to act on it
supporting
is based on an advocate’s belief that a client’s decision is consistent with the client’s values and goals
affirming
when the nurse, client, professionals, or significant others generate as many alternatives as possible, without placing a value on them
brainstorming
a way to broaden limited thinking. it involves restating the problem and expanding the problem statement so that different solutions can be generated.
problem-purpose-expansion method
is a staple of marker competition. nurses perform these roles when they triage clients or perform the gatekeeping and rationing functions
allocation
is a strategic process used to move conflicting parties toward an outcome.
negotiating
the outcome in which one party gains benefit at the other’s expense
distributive outcome
an outcome in which mutual advantages override individual gains
integrative outcomes.
is the ability to present one’s own needs
assertiveness
is the ability to understand and meet the needs of others
cooperation
is achieved through a developmental process.
is a dynamic, highly interactive, and interdependent process in which people work together, sharing resources and even a vision for a goal
collaboration
individual’s right to choose a provider, if a particular provider is not approved by the case management system
autonomy
doing good
beneficence
is defined as faithfulness to the obligation of duty
fidelity
