Ch. 2 (Health Care Delivery System)- Key Terms Flashcards
Adult day care centers
Facility for the supervised care of older adults; provides activities such as meals and socialization during specified day hours
Assisted living
Residential living facilities in which each resident has his or her own room and shares dining and social activity areas
Capitation
Payment mechanism in which a provider (such as healthcare network) receives a fixed amount of payment per enrollee
Diagnosis-related groups (DRGs)
Group of patients classified to establish a mechanism for health care reimbursement based on length of stay. Classification is based on the following variables: primary and secondary diagnosis, co-morbidities, primary and secondary procedures, and age
Discharge planning
Activities directed toward identifying future proposed therapy and the need for additional resources before and after returning home
Extended care facility
Institution devoted to providing medical, nursing, or custodial care for an individual over a prolonged period such as during the course of a chronic disease or the rehabilitation fees after an acute illness
Globalization
World wide scope or application
Home care
Health service provided in the patient’s place of residence to promote, maintain, or restore health or minimize the effects of illness and disability
Hospice
System of family-centered care designed to help terminally ill people be comfortable and maintain a satisfactory lifestyle throughout the terminal phase of their illness
Independent practice association (IPA)
Managed care organization that contracts with physicians or healthcare providers who usually are members of groups and whose practices include fee-for-service and capitated patients
Integrated delivery network (IDN)
Set of providers and services organized to deliver a coordinated continuum of care to the population of patients served at a capitated cost
Managed care
Healthcare system in which there is administrative control over primary healthcare services. Redundant facilities and services are illuminated, and costs are reduced. Preventive care and health education are emphasized
Medicaid
P. 16 chart
State medical assistance to people with low incomes: Low income families, long term care disabilities, older adults, Poor children, their parents, pregnant women, disabled very poor adults
Medicare
Health insurance program for people over 65 years of age. Administered into parts: part A, basic protection against cost of medical, surgical, and psychiatric hospital care; part B, voluntary medical insurance program financed in part from federal funds and in part from premiums contributed by people enrolled in the program
Minimum data set (MDS)
Required by the Omnibus budget reconciliation act of 1987;
A uniform dataset established by the department of health and human services; framework for any state specified assessment Instruments used to develop a written and comprehensive plan of care for newly admitted residents of nursing facilities
Nursing informatics
A competency for nurses; uses information and technology to communicate, manage knowledge, mitigate error, and support decision-making
Examples: taking blood pressure or measurement of the patient’s wound
Nursing-sensitive outcomes
Outcomes that are within the scope of nursing practice; consequences or effects of nursing interventions that result in changes in the patient’s symptoms, functional status, safety, psychological distress, or costs
Patient-centered care
Concept to improve work efficiency by changing the way that patient care is delivered
Pay for performance
Quality improvement program that rewards excellence through financial incentives to motivate change to achieve measurable improvements and improve patient care quality and safety
Primary healthcare
Combination of primary and public health care that is accessible to individuals and families in the community and provided at an affordable cost
Professional standards review organizations (PSROs)
Focuses on evaluation of nursing care provided in a healthcare setting. The quality, effectiveness, and appropriateness of nursing care for the patient are the focus of evaluation
Prospective payment system
Payment mechanism for reimbursing hospitals for inpatient Healthcare Services in which a predetermined rate is set for treatment of specific illnesses
Rehabilitation
Restoration of an individual to normal or near-normal function after physical or mental illness, injury, or chemical addiction
Resource utilization groups (RUGs)
Method of classification for healthcare reimbursement for long-term care facilities
