Chapter 2 The Settings for Health Care Delivery

Question 1

Healthcare delivered in

Answer 1

inpatient or ambulatory

Question 2

Inpatient settings

Answer 2

general and short term hospitals

long term care facilities such as nursing homes and skilled nursing facilities and others

Question 3

Ambulatory settings

Answer 3

surgery centers (ASC), medical group practices 
Community health centers (CHC)
dialysis centers
urgent care centers 
retail clinics 
imaging centers
sleep centers
catheterization labs 
vascular access centers 
telemedicine providers 
workplace 
school clinics

Question 4

A wide range of health care services also delivered in the home

Answer 4

usually less expensive and more convenient for the patient than the care provided in a hospital or skilled nursing facility

Question 5

The requirements for being a hospital and what services can or cannot be performed in a hospital differ by state, with some commonality due to participation in federal government programs

Answer 5

such as Medicare and Medicaid

Question 6

Community-based care

Answer 6

self-care/ambulatory care

Question 7

Hospitals

Answer 7

inpatient acute care

Question 8

Postacute care

Answer 8

Long term care: adult day care, home health care, hospice, skilled nursing facilities, and residential care facilities

Question 9

Ambulatory rehabilitation centers

Answer 9

rehab centers

Question 10

Long-term acute care and other specialty hospitals

Answer 10

Long term and specialty hospitals

Question 11

Value-based reimbursement puts financial pressure on providers, health care organizations are striving for efficiency, cost control, and sustainability. An increasingly popular strategy to fulfill all these goals is to engage in hospital merger and acquisition activity.
Hospital mergers in 2017 =115
The first half of 2018 = 50

Answer 11

Value-based reimbursements and mergers

Question 12

Self care the vast majority of people will not receive inpatient acute care in any given year.

Answer 12

An estimated 80% to 95% of health problems are never brought forward to a physician or otherwise involve professional medical care. Frequently ailments perceived to be minor are either addressed with a “take no action”, “wait and see” or self-medication approach.

Question 13

Fevers, headaches, and indigestion are among the most common ailments treated with non-prescription or “over the counter” medications

Answer 13

Levin and Idler- “Self-care refers to those activities individuals undertake in promoting their own health, preventing their own disease, limiting their own illness, and restoring their own health. These activities and undertaken without professional assistance although individuals are informed by technical knowledge and skills derived from the pool of both professional and lay experience.

Question 14

Ambulatory care

Answer 14

refers to medical services performed without admission to a hospital or other health care facility for an overnight stay.

Question 15

Ambulatory care 2.0

Answer 15

physician offices, emergency departments, and hospital outpatient clinics

Question 16

Ambulatory care settings

Answer 16

Public health clinics
Neighborhood and community health centers
Industrial and other workplace clinics
School health clinics

Question 17

Emerging and expanding ambulatory settings

Answer 17

telehealth
physician home visits
retail pharmacies
diagnostic imaging and laboratory centers
ambulatory surgery centers and, more generally, ambulatory procedure centers
Urgent care centers

Question 18

Primary care

Answer 18

is a whole of society approach to health and well-being centered on the needs and preferences of individuals, families, and communities. It addresses the broader determinants of health and focuses on the comprehensive and interrelated aspects of physical, mental, and social health and wellbeing.

Question 19

Primary care

Answer 19

whole-person care for health needs throughout the lifespan, not just for a set of specific diseases
Primary health care ensures people receive comprehensive care ranging from promotion and prevention to treatment, rehabilitation, and palliative care-as close as feasible to people’s everyday environment.

Question 20

The primary reason for physician visits in 2016

Answer 20

General medical examination 
Routine prenatal examination
Postoperative visit
Medication 
Cough
Well-baby examination
Hypertension
Knee symptoms
Preoperative visit

Question 21

Hospital emergency departments

Answer 21

are part of a hospital system

Question 22

The original intention of hospital Emergency departments

Answer 22

A
to take care of acutely ill or injured people
particularly with life-threatening and potentially life-threatening problems that require immediate attention by personnel or equipment not found in private practitioners offices

B
to offer prompt hospitalization if needed

Question 23

Emergency departments also

Answer 23

serve as a secondary, well-equipped private physician’s office, with more sophisticated resources than are available in a typical doctor’s office.

Another role that became increasingly important after WWII
Have not seen or can not reach their private physician
The regular clinic is not opened when needed
Find that their regular or covering health maintenance organization assigned primary care gatekeeper physician is not available
Geographically out of the region
Have no insurance and no place else to go when sick

Question 24

Emergency department

Answer 24

considered acute service typically staffed and managed to be ready to treat patients of any acuity the hospital is capable of, most patients who come to the ED will not be admitted and do no have life-threatening illnesses or injuries.

Question 25

ESI = Emergency Service Index

Answer 25

triage system that uses five levels to triage patients. More than half of ED’s use the esi triage system.
Triage chart on pg 41

Question 26

One intent of the Affordable Care Act (ACA)

Answer 26

was to reduce unnecessary ED utilization by uninsured people by providing health insurance, better health insurance, and comprehensive primary care that would address the problem.
Statistics regarding utilization of ED on pg 42

Question 27

Top 10 reasons (2016) for visiting Emergency Department

Answer 27

Stomach and abdominal pain, cramps, and spasms 
Chest pain and related systems 
Fever 
Cough
Headache, pain in the head 
Back symptoms 
Pain, site not referable to a specific body part
Shortness of breath 
Accident, not otherwise specified 
Vomitting

Question 28

Most emergency room visits considered

Answer 28

level 3 urgent on esi or 4 semiurgent on esi

Question 29

Greatest utilization of emergency departments

Answer 29

was in the West and the lowest in the northeast

Question 30

OPD

Answer 30

outpatient department

Question 31

Majority of OPD visits

Answer 31

occur in voluntary hospitals and in government-owned hospitals. The majority of opd visits occur in general medicine clinics. The other top OPD clinic types are:
surgery 
pediatrics
obstetrics
gynecology

Question 32

HIstory on clinics

Answer 32

bottom of pg 44

Question 33

In 1908 the Goshen Hospital was established

Answer 33

Route 17 the road went through the center of the village of Goshen. Traffic accidents occurred with increasing frequency.

Question 34

10 most common reasons for OPD visits in 2011

Answer 34

Progress visit
General medical examination
Post operative visit
Meditation
Counseling
Cough 
Routine prenatal examination 
Diabetes
Symptoms of the throat 
Well-baby examination

Question 35

The highest rate of OPD

Answer 35

visits were in the Northeast and the lowest was in the West pg 46