Ch. 2 The health care delivery system

Question 1

Institute of Medicine (IOM) vision

Answer 1

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

Question 2

Professional standards review organization (PSROs)

Answer 2

Review quality, quantity, and cost of hospital care through medicare and medicaid.

Question 3

Utilization review (UR) committees

Answer 3

Review admissions, and identify and eliminate overuse of diagnostic and treatment services ordered by physicians on Medicare.

Question 4

Prospective payment system (PPS)

Answer 4

Eliminated cost-based reimbursement.

Question 5

Diagnosis-related groups (DRGs)

Answer 5

Hospitals receive a set or fixed dollar amount based on an assigned group based on case severity, rural/urban/regional costs, and teaching costs.

Question 6

Capitation

Answer 6

Providers receive a fixed amount per patient.

Question 7

Resource utilization groups (RUGs)

Answer 7

Used in long term care to manage costs so the organizations remain profitable.

Question 8

Managed care

Answer 8

Providers or health care system receives a predetermined capitated payment for each patient.

Question 9

Never Events

Answer 9

Which are devastating and preventable. Are organized in seven categories: surgical, product or device, patient protection, care management, environmental, radiological, and critical.

Question 10

Integrated delivery networks (IDNs)

Answer 10

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.

Question 11

Primary care

Answer 11

1) Prenatal and well baby care
2) Nutrition counseling
3) Family planning
4) Exercise and meditation classes

Question 12

Preventive care

Answer 12

1) BP and cancer screening
2) immunization
3) mental health counseling and crisis prevention
4) community legislation (seat belts, bike helmets)

Question 13

Secondary acute care

Answer 13

1) emergency care
2) acute medical surgical care
3) radiological procedures for acute problems

Question 14

Tertiary care

Answer 14

1) intensive care

1) subacute care

Question 15

Restorative care

Answer 15

1) cardio and pulmonary rehab
2) orthopedic rehab
3) sports medicine
4) spinal cord injury programs
5) home care

Question 16

Continuing care

Answer 16

1) assisted living

2) psychiatric and older adult day care

Question 17

Define primary health care

Answer 17

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.

Question 18

Define preventive care

Answer 18

Is more disease orientated and focused on reducing and controlling risk factors for disease.

Question 19

Examples of acute care facilities

Answer 19

1) emergency departments
2) urgent care centers
3) critical care units
4) medical-surgical units

Question 20

Discharge planning begins

Answer 20

the moment a pt is admitted to a health care facility.

Question 21

Define restorative care

Answer 21

help individuals regain maximal functional status and enhance quality of life through independence and self-care.

Question 22

Extended care facility

Answer 22

provides intermediate medical, nursing, or custodial care for patients recovering from acute illness or disabilities.

Question 23

intermediate care/skilled nursing facility

Answer 23

provides care for patients until they can return to their community or residential care location.

Question 24

Home care services include?

Answer 24

1) nursing
2) medical and social services
3) physical, occupational , speech, and respiratory therapy
4) nutritional therapy

Question 25

Examples of home nursing care?

Answer 25

1) monitoring of vital signs
2) administration of parenteral or enteral nutrition
3) IV or blood therapy
3) wound care
4) respiratory care

Question 26

Rehabilitation

Answer 26

Restores a person to the fullest physical, mental, social, vocational, and economic potential possible.

Question 27

Define continuing care

Answer 27

services are for people who are disabled, not functionally independent or who suffer a terminal disease.

Question 28

Nursing center

Answer 28

24 hour intermediate and custodial care.

Question 29

Assisted living

Answer 29

long-term care setting with greater resident autonomy.

Question 30

Respite care

Answer 30

provides short-term relief or “time off” to the family members who are caring for the patient.

Question 31

Adult day care center

Answer 31

allows patients to retain more independence by living at home. People who live alone or with family in the community.

Question 32

Hospice

Answer 32

focus of care is palliative, not curative, treatment.

Question 33

Accountable care organizations (ACO)

Answer 33

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.

Question 34

Patient care medical home (PCMH)

Answer 34

Make care for patients more efficient, effective, continuous, comprehensive, patient centered, and coordinated. The primary care providers function as the hub of the PCMH.

Question 35

Issues to nursing shortage

Answer 35

1) aging baby boomer
2) slow growth in nursing school enrollments
3) nursing faculty shortages
4) space limitations
5) clinical site availability

Question 36

What are the five interrelated competencies that are essential for all health care workers by institute of medicine?

Answer 36

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

Question 37

quality health is ?

Answer 37

The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.

Question 38

The goal of pay for performance programs?

Answer 38

Reward excellence through financial incentives to motivate change to achieve measurable improvements.

Question 39

Hospital consumer of assessment of healthcare and systems (HCAHPS) is?

Answer 39

A standardized survey developed to measure patient perceptions of their hospital experience.

Question 40

Vulnerable population are identified as?

Answer 40

1) Children
2) women
3) older adults

Question 41

Concepts of patient centered care include?

Answer 41

1) respect and dignity
2) sharing of information
3) participation in care and care decisions
4) collaboration

Question 42

Health care organizations that apply for magnet status must demonstrate?

Answer 42

1) Quality patient care
2) Nursing excellence
3) Innovations in professional practice

Question 43

Define globalization

Answer 43

Increased connectedness of the world’s economy, culture, and technology.

Question 44

Nursing sensitive outcomes

Answer 44

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.

Question 45

The revised Magnet model has five components status must demonstrate?

Answer 45

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

Question 46

Quality improvement

Answer 46

An approach to the continuous study and improvement of the processes of providing health care services to meet the needs of patients.

Question 47

Performance improvement

Answer 47

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.

Question 48

Quality improvement programs ?

Answer 48

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.