CH 2 healthcare delivery system Flashcards
profession’s values are rooted in helping people to regain, maintain, or improve their health; prevent illness; and find comfort and dignity at a time of death.
Nursing
present a challenge to health care and nursing because they are more likely to skip or delay treatment for acute and chronic illnesses and die prematurely
Patients who are uninsured
preventive, primary, secondary, tertiary, restorative, and continuing health care.
US health care system has six levels of care for which health care providers offer services:
describe the scope of services and settings delivered by health care providers to patients in all 15stages of health and illness.
Levels of care
preventive, primary, secondary, tertiary, restorative, and continuing health care
six levels of care for which health care providers offer services:
- Adult screenings for blood pressure, cholesterol, tobacco use, and cancer
- Pediatric screenings for hearing, vision, autism, and developmental disorders
- HIV screening for adults at higher risk
- Wellness visits
- Immunizations
- Diet counseling
- Mental health counseling and crisis prevention
- Community legislation (seat belts, car seats for children, bike helmets)
Preventive Care
- Diagnosis and treatment of common illnesses
- Ongoing management of chronic health problems
- Prenatal care
- Well-baby care
- Family planning
- Patient-centered medical home
Primary Care (Health Promotion)
- Urgent care; hospital emergency care
- Acute medical-surgical care: ambulatory care, outpatient surgery, hospital
- Radiological procedures
Secondary (Acute Care)
- Highly specialized: intensive care, inpatient psychiatric facilities
- Specialty care (such as neurology, cardiology, rheumatology, dermatology, oncology)
Tertiary Care (acute care)
- Rehabilitation programs (such as cardiovascular, pulmonary, orthopedic)
- Sports medicine
- Spinal cord injury programs
- Home care
Restorative Care
- Long-term care: assisted living, nursing centers
* Psychiatric and older-adult day care
Continuing Care
health promotion and disease prevention
- preventing pneumonia through repositioning a patient frequently
(primary prevention),
curing of disease
-ex: administering antibiotics on time to treat the pneumonia
(secondary prevention)
reducing complications
- ex: intensive care unit,
- assessing the patient frequently for signs of antibiotic intolerance.
tertiary prevention
focuses on the health of populations and their communities rather than simply curing an individual’s disease
Wellness care
is “a network of organizations that provides or arranges to provide a coordinated continuum of services to a defined population and is willing to be held clinically and fiscally accountable for the outcomes and health status of the population served”
integrated health care delivery system
an organizational structure that follows economic imperatives (such as combining financing with all providers, from hospitals, clinics, and physicians to home care and long-term care facilities) and a structure that supports an organized care delivery approach (coordinating care activities and services into seamless functioning)
two types of integrated health care systems are found:
focuses on improved health outcomes for an entire population.
- includes primary care and health education, proper nutrition, maternal/child health care, family planning, immunizations, and control of diseases
Primary health care
such as schools, physicians’ offices, occupational health clinics, community health centers, and nursing centers, health promotion is a major theme
patients receive preventive and primary care(setting)
are designed to lower the overall costs of health care by reducing the incidence of disease, minimizing complications, and thus reducing the need to use more expensive health care resources.
Health promotion programs
is more disease oriented and focused on reducing and controlling risk factors for disease through activities such as immunization and occupational health programs.
preventive care
is through psychiatric care.
Counseling
Health promotion and education are traditionally the
primary objectives of home care
analysis is a method that focuses on improvement of processes in a health care institution.
Value stream
are transformational leadership; structural
empowerment; exemplary professional practice; new knowledge, innovation, and improvements; and empirical quality results
Magnet Recognition Program ( 5 components)
established the Magnet Recognition Program
American Nurses Credentialing Center (ANCC)
to recognize health care
organizations that achieve excellence in nursing practice.
Magnet Recognition Program
School health,Occupational health, Physicians’ offices, Nurse-managed clinics, Block and parish nursing, Community centers
Preventive and Primary Care Services
is provided by a specialist or agency upon referral by a primary health care provider. It requires more specialized knowledge, skill, or equipment than the primary care physician
Secondary health care
is specialized consultative care, usually provided on referral from secondary medical personnel. For example, the cardiac surgeon sees the patient referred from the cardiologist for possible cardiac bypass surgery.
Tertiary health care
general inpatient services but have limited emergency and diagnostic services
-exception is critical access hospitals
small rural hospitals offer
comprehensive, state-of-the-art diagnostic services, trauma and emergency care, surgical intervention, intensive care units (ICUs), inpatient services, and rehabilitation centers.
large urban medical centers offer
delivering the right care, at the right time, in the right setting is the core mission of hospitals across the country
American Hospital Association (2017)
is a hospital unit in which patients receive close monitoring and intensive medical care
-ICU MOST EXPENSIVE
(delivery care) CUZ CAN ONLY CARE 1-2 PT AT TIMR
ICU or critical care unit
Patients who have emotional and behavioral problems such as depression, mood disorders, violent behavior, and eating disorders
require special counseling and treatment in psychiatric facilities.
in hospitals, independent outpatient clinics, and private mental health hospitals
psychiatric facilities that do exist are located
(1) economic factors (rural Americans are more likely to live below the poverty level), (2) cultural and social differences, (3) lower levels of education, (4) lack of attention to rural problems by legislators, and (5) isolation of living in remote rural areas
Rural Americans Healthcare of factors that create disparities NOT found in urban (city) areas
changed the designation of some rural hospitals to Critical Access Hospital (CAH) when certain criteria were met
Balanced Budget Act of 1997 (pertaining rural hospitals)
(35 miles from another hospital) and provides 24-hour emergency care with no more than 25 inpatient beds for temporary care for 96 hours or less to patients needing stabilization before transfer to a larger hospital.
Critical Access Hospital (CAH) is located in a rural area
Reimbursements are affected by the quality and timeliness of care.
Health care payers, such as Centers of medicare and medicaid and private insurers, expect patients who are hospitalized to be treated and discharged within a reasonably predictable time period.
you may collaborate with members of the interprofessional health care team, such as case managers, advanced practice providers such as nurse practitioners, physical therapists, physicians, and social workers, to plan a quick yet realistic transition to another level of health care.
discharge planning.
is a coordinated, interprofessional process that develops a plan for continuing care after a patient leaves a health care agency.
Discharge planning
patients within acute care hospitals have an average length of stay (LOS) of only 2 to 3 days. Thus, discharge planning with coordination of services must begin the moment a patient is admitted to a hospital.
according to Department of Health and Human Services and Centers for Medicare and Medicaid Services (DHHS-CMS) (2017),
Emphasizes the role of a transition coach in managing/facilitating the discharge of a patient to home or to a rehabilitation center. Model is based on four pillars: (1) medication self-management,
(2) patient-centered record,
(3) follow-up,
(4) indicators of worsening medical condition. Each pillar has different interventions depending on the stage of the hospitalization.
Coleman’s “Care Transitions Program” (discharge plan)
Emphasizes comprehensive discharge planning and follow-up for older adults who are chronically ill. Model contains six key components:
(1) in-hospital assessment and development of the discharge care plan by a transitional care nurse/advanced practice nurse/gerontological nurse;
(2) discharge preparation by an interprofessional care team;
(3) patient participation (communication between nursing staff and the patient) regarding the process, the decision making, the discharge planning, and the discharge education;
(4) continuity of care and communication among health care providers;
(5) predischarge assessment;
(6) postdischarge follow-up.
Naylor’s “Transitional Care Model” (discharge plan)
The team is headed by both a nurse practitioner and a social worker. This team works in tandem to support the primary care physician and, following best practice protocols, to fully address a patient’s health conditions. The focus is to help patients manage their health conditions, coordinate their health care, and achieve optimal health
High-intensity Care Team (discharge plan)
discharge medications, follow-up care (if needed), list of all medications changed and/or discontinued, dietary needs, and follow-up tests or procedures.
following are required discharge instruction topics (The Joint Commission [TJC],:
are to help individuals regain maximal functional status and to enhance quality of life through promotion of independence and self-care.
restorative care
is the provision of medically related professional and paraprofessional services and equipment to patients and families in their homes for health maintenance, education, illness prevention, diagnosis and treatment of disease, palliation, and rehabilitation.
Home care
patient-specific comprehensive assessments at a patient’s start of care, at 60-day follow-ups, at discharge, and before and after an inpatient stay
Nurses who work in Medicare-certified home care agencies conduct
to gather the data items needed to measure both outcomes and patient risk factors in the home setting.
OASIS (the Outcome and Assessment Information Set) assessment tool was designed// Home care
socio-demographic, environmental, support system, health status, functional status, and health service utilization characteristics of a patient
Data items within OASIS include
employ skilled and intermittent professional services, such as wound care, administering parenteral and enteral nutrition, administering medications and blood therapy, and home care aide services. These services usually are delivered once or twice a day as often as 7 days a week.
Home care agencies
as the process aimed at enabling people with disabilities to reach and maintain their optimal physical, sensory, intellectual, psychological, and social functional levels
The World Health Organization (WHO) defines rehabilitation
Patients require rehabilitation after a physical or mental illness, injury, or chemical addiction.
require rehabilitation
cardiovascular, neurological, musculoskeletal, pulmonary, and mental health rehabilitation programs
rehabilitation INCLUDES
provides intermediate medical, nursing, or custodial care for patients recovering from acute illness or those with chronic illnesses or disabilities
extended care facility
intermediate care and skilled nursing facilities. Some include long-term care and assisted-living facilities.
Extended care facilities include
IV fluids, wound care, long-term ventilator management, and physical rehabilitation.
intermediate care or skilled nursing facility (Extended care facility )
services are for people who are disabled, who were never functionally independent, or who suffer a terminal disease.
-(e.g., nursing centers or nursing homes, group homes, and retirement communities), communities (e.g., adult day care and senior centers), or the home (e.g., home care, home-delivered meals, and hospice)
Continuing Care
typically provides 24-hour intermediate and custodial care such as nursing, rehabilitation, dietary, recreational, social, and religious services for residents of any age with chronic or debilitating illnesses
nursing center aka nursing facility/ used to be nursing home
- Skilled nursing
- Rehabilitation
- Long-term care
Nursing center services provided by Medicaid-certified nursing homes, offer:
helps nursing facility staff gather definitive information on a resident’s strengths and needs, which must then be addressed in an individualized care plan
RAI (Resident Assessment Instrument)
the Minimum Data Set (MDS) Version 3.0, the Care Area Assessment (CAA) process, and the RAI Utilization Guidelines
RAI has three components: (continuum care)
a resident’s functional status, strengths, weaknesses, and preferences, as well as offering guidance on further assessment once problems have been identified
components of the RAI yield information about
is an initial overview of a resident’s health care needs
-preliminary assessment to identify the resident’s potential problems, strengths, and preferences
MDS Version 3.0 (minimum data set)
which form a critical link between the MDS and decisions about care planning. CAAs enable facilities to identify and use tools that are grounded in current clinical standards of practice, such as evidence-based or expert-endorsed research, clinical practice guidelines, and resources.
triggered care areas (RAI)
offers an attractive long-term care setting with an environment more like home and greater resident autonomy
Assisted living
laundry, assistance with meals and personal care, 24-hour oversight, and housekeeping
Services in an assisted-living center include
is a service that offers short-term relief by providing a new environment or time to relax for family caregivers who support the ill, disabled, or frail older adult
Respite care
provided at home by a friend, another family member, a volunteer, by a paid service, or in a care setting such as adult day care or a residential center
Respite care
provide a variety of health and social services to specific patient populations who live alone or with family in the community.
-associated with a hospital or nursing home or exist as independent centers
Adult day care centers
Palliative care is a holistic, patient- and family-centered care approach with a goal of improving the quality of life of patients and families who are experiencing problems related to life-threatening illnesses.
Palliative care
is a system of family-centered care that allows patients to live with comfort, independence, and dignity while easing the pain of terminal illness
hospice
that best meets the needs of each patient and family, such as in a patient’s home, in nursing homes, assisted living facilities, freestanding hospices, and hospitals
Hospice care is provided in a setting
establishes a system of payment for the operating costs of acute care hospital inpatient stays under Medicare Part A (hospital insurance) based on prospectively set rates
Social Security Act
Social Security Act establishes a system of payment for the operating costs of acute care hospital inpatient stays under Medicare Part A (hospital insurance) based on prospectively set rates
Reffered to as inpatient prospective payment system (IPPS)
testing new payment and service delivery models, evaluating results and advancing best practices, and engaging a broad range of stakeholders to develop additional models for testing
Innovation Center supports the following priorities:
. is a patient satisfaction measure that sets a national standard for collecting or publicly reporting patients’ perceptions that enables users to make valid comparisons across all hospitals
HCAHPS(Hospital Consumer Assessment of Healthcare Providers and Systems)//Hospital Value-Based Purchasing
This CMS program reduces Medicare payments to hospitals with excess patient readmissions within 30 days of hospital discharge.
-include heart attack, heart failure, pneumonia, chronic obstructive pulmonary disease, and knee and hip replacements
Hospital Readmissions Reduction Program
Certain health care organizations are testing whether bundled payments (single payment for all services performed to treat a patient) for a specific episode of care (inpatient stays in an acute care hospital) can better coordinate care for Medicare patients and reduce Medicare costs.
Bundled Payments for Care Improvements:
hospitals that have a high incidence of HACs, such as pressure injury development, catheter-associated urinary tract infections, central line–associated bloodstream infections, surgical site infections, and Clostridium difficile in patients, received reduced or no funding from CMS for the treatment of these HACs
Hospital Acquired Condition (HAC) Reduction Program
has a member of the unit’s health care team rounding hourly on each patient using an established protocol
IR (Intentional rounding )
were developed by the Massachusetts Department of Higher Education (DHE) and the Massachusetts Organization of Nurse Executives (MONE) to identify knowledge, attitude, and skills for 10 competencies considered essential for the registered nurse for the future
The Massachusetts Nurse of the Future Nursing Core Competencies
- Patient-Centered Care
- Teamwork and Collaboration
- Evidence-Based Practice (EBP)
- Quality Improvement (QI)
- Safety
- Informatics
QSEN (Quality and safety education for nurses) Competencies
- Patient-Centered Care
- Professionalism
- Leadership
- Systems-Based Practice
- Informatics and Technology
- Communication
- Teamwork and Collaboration
- Safety
- Quality Improvement
- Evidenced-Based Practice (EBP)
Massachusetts Nurse of the Future Nursing Core Competencies
“care that is respectful of and responsive to individual patient preferences, needs, and values and (ensures) that patient values guide all clinical decisions”
In a landmark report, Crossing the Quality Chasm, the Institute of Medicine (IOM) defines patient-centered care as
- Respect for patients’ values, preferences, and expressed needs
- Coordination and integration of care
- Information and education
- Physical comfort
- Emotional support and alleviation of fear and anxiety
- Involvement of family and friends
- Continuity and transition
- Access to care
Picker Institute’s eight principles of patient-centered care
established the Magnet Recognition Program® to recognize health care organizations that achieve excellence in nursing practice
The American Nurses Credentialing Center (ANCC)
The five components are
(1) Transformational Leadership,
(2) Structural Empowerment,
(3) Exemplary Professional Practice,
(4) New Knowledge, Innovation, and Improvements, and (5) Empirical Quality Results
The Magnet® Model has five components affected by global issues that are challenging nursing today
—Focus is on structure and processes and demonstration of positive clinical, workforce, and patient and organizational outcomes.
Empirical quality outcomes
—A vision for the future and the systems and resources to achieve the vision are created by nursing leaders.
Transformational leadership
—Structures and processes provide an innovative environment in which staff are developed and empowered and professional practice flourishes.
Structural empowerment
Contributions are made to the profession in the form of new models of care, use of existing knowledge, generation of new knowledge, and contributions to the science of nursing.
New knowledge, innovations, and improvements—
are patient outcomes and nursing workforce characteristics that are directly related to nursing care, such as changes in patients’ symptom experiences, functional status, safety, psychological distress, RN job 27satisfaction, total nursing hours per patient day, and costs.
Nursing-sensitive outcomes
are differences in health care outcomes and dimensions of health care, including access, quality, and equity, among population groups
Health care disparities
recognizes that health starts in our homes, schools, workplaces, and communities
Healthy People 2020
