Ch. 2 The health care delivery system Flashcards
Institute of Medicine (IOM) vision
1) Practice to the full extend of their training
2) Achieving higher levels of education & training
3) Partners with physicians and other health care providers to redesign health care system
4) Improve data collection and the information for planning and policy making
Professional standards review organization (PSROs)
Review quality, quantity, and cost of hospital care through medicare and medicaid.
Utilization review (UR) committees
Review admissions, and identify and eliminate overuse of diagnostic and treatment services ordered by physicians on Medicare.
Prospective payment system (PPS)
Eliminated cost-based reimbursement.
Diagnosis-related groups (DRGs)
Hospitals receive a set or fixed dollar amount based on an assigned group based on case severity, rural/urban/regional costs, and teaching costs.
Capitation
Providers receive a fixed amount per patient.
Resource utilization groups (RUGs)
Used in long term care to manage costs so the organizations remain profitable.
Managed care
Providers or health care system receives a predetermined capitated payment for each patient.
Never Events
Which are devastating and preventable. Are organized in seven categories: surgical, product or device, patient protection, care management, environmental, radiological, and critical.
Integrated delivery networks (IDNs)
Network of facilities, providers, and services organized to deliver a continuum of care to a population of patients at a capitated cost in a setting.
Primary care
1) Prenatal and well baby care
2) Nutrition counseling
3) Family planning
4) Exercise and meditation classes
Preventive care
1) BP and cancer screening
2) immunization
3) mental health counseling and crisis prevention
4) community legislation (seat belts, bike helmets)
Secondary acute care
1) emergency care
2) acute medical surgical care
3) radiological procedures for acute problems
Tertiary care
1) intensive care
1) subacute care
Restorative care
1) cardio and pulmonary rehab
2) orthopedic rehab
3) sports medicine
4) spinal cord injury programs
5) home care
Continuing care
1) assisted living
2) psychiatric and older adult day care
Define primary health care
focuses on improved health outcomes for an entire population. Health promotion programs lower the overall costs of heath care:
reducing incidence of disease
minimizing complications
reducing the need to use more expensive health care resources.
Define preventive care
Is more disease orientated and focused on reducing and controlling risk factors for disease.
Examples of acute care facilities
1) emergency departments
2) urgent care centers
3) critical care units
4) medical-surgical units
Discharge planning begins
the moment a pt is admitted to a health care facility.
Define restorative care
help individuals regain maximal functional status and enhance quality of life through independence and self-care.
Extended care facility
provides intermediate medical, nursing, or custodial care for patients recovering from acute illness or disabilities.
intermediate care/skilled nursing facility
provides care for patients until they can return to their community or residential care location.
Home care services include?
1) nursing
2) medical and social services
3) physical, occupational , speech, and respiratory therapy
4) nutritional therapy
Examples of home nursing care?
1) monitoring of vital signs
2) administration of parenteral or enteral nutrition
3) IV or blood therapy
3) wound care
4) respiratory care
Rehabilitation
Restores a person to the fullest physical, mental, social, vocational, and economic potential possible.
Define continuing care
services are for people who are disabled, not functionally independent or who suffer a terminal disease.
Nursing center
24 hour intermediate and custodial care.
Assisted living
long-term care setting with greater resident autonomy.
Respite care
provides short-term relief or “time off” to the family members who are caring for the patient.
Adult day care center
allows patients to retain more independence by living at home. People who live alone or with family in the community.
Hospice
focus of care is palliative, not curative, treatment.
Accountable care organizations (ACO)
Developed to coordinate medical care by primary care and specialty physicians, hospitals, and other providers with the goal of coordination. Nurses act as leaders and care coordinators.
Patient care medical home (PCMH)
Make care for patients more efficient, effective, continuous, comprehensive, patient centered, and coordinated. The primary care providers function as the hub of the PCMH.
Issues to nursing shortage
1) aging baby boomer
2) slow growth in nursing school enrollments
3) nursing faculty shortages
4) space limitations
5) clinical site availability
What are the five interrelated competencies that are essential for all health care workers by institute of medicine?
1) patient-centered care (recognize/respect differences in patient’s value, preferences, and needs)
2) work in interdisciplinary teams
3) use evidence-based practice
4) apply quality improvement
5) use informatics
quality health is ?
The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.
The goal of pay for performance programs?
Reward excellence through financial incentives to motivate change to achieve measurable improvements.
Hospital consumer of assessment of healthcare and systems (HCAHPS) is?
A standardized survey developed to measure patient perceptions of their hospital experience.
Vulnerable population are identified as?
1) Children
2) women
3) older adults
Concepts of patient centered care include?
1) respect and dignity
2) sharing of information
3) participation in care and care decisions
4) collaboration
Health care organizations that apply for magnet status must demonstrate?
1) Quality patient care
2) Nursing excellence
3) Innovations in professional practice
Define globalization
Increased connectedness of the world’s economy, culture, and technology.
Nursing sensitive outcomes
Are patient outcomes and selcet nursing workforce characteristics that are directly related to nursing. Example: changes in patient symptom experiences, functional status, safety, psychological distress, RN, Job satisfaction, total nursing hours per patient day, and costs.
The revised Magnet model has five components status must demonstrate?
1) Quality patient care
2) Nursing excellence
3) Innovations in professional practice
4) Transformational leadership
5) structural empowerment
6) exemplary professional practice
7) new knowledge, innovations, and improvements
8) empirical quality outcomes
Quality improvement
An approach to the continuous study and improvement of the processes of providing health care services to meet the needs of patients.
Performance improvement
An organization analyzes and evaluates current performance and uses the results to develop focused improvement actions. Performance improvement activities are typically clinical projects conceived in response to identified clinical problems and designed to use research findings to improve clinical practice.
Quality improvement programs ?
1) PDSA (Review, select an intervention, study/evaluate, act on the practices)
2) Six Sigma or Lean - processes to reduce costs, enhance quality, revenue, and improve teamwork.
3) Rapid cycle improvement or rapid-improvement event (RIE) - week long events where a group get together to evaluate a problem with the intent of making radical changes to current processes.
