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Professionalism II > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

How does the Triple Aim strive to lower healthcare costs?

A

by reducing waste in healthcare and increasing the value of care

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2
Q

What is included in the triple aim?

A

Population health
Experience of care
Per capita cost

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3
Q

The Triple Aim was created by what organization?

A

Institute for Healthcare Improvement

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4
Q

By saving money that’s wasted in healthcare every day we could:

A

improve healthcare quality
improve health of populations

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5
Q

What CDS? A nurse is reviewing a clients lab and can’t remember the normal range for BUN?

A

Evidence Button

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6
Q

What CDS? An orthopedic surgeon has a set of orders for a TKR?

A

Provider Order Sets

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7
Q

What CDS? A nurse scans a client’s id bracelet and then a medication?

A

Barcoding

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8
Q

What CDS? A nurse is preparing to administer Enoxaparin to a client and receives an alert stating the client is also on Warfarin?

A

Drug Database

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9
Q

What CDS? A nurse receives a pop-up alert when a client is a high risk for skin breakdown?

A

If-Then Logic

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10
Q

What CDS? A nurse chooses a pre-designed care plan related to airway management?

A

Prescriptive Plan of Care

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11
Q

What CDS? A nurse is completing the client’s admission and is able to review past medical history?

A

Electronic Form

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12
Q

What does CDS stand for?

A

Clinical Decision Support System

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13
Q

5 Rights of CDS?

A
  1. Right information
  2. Right people
  3. Right channels
  4. Right intervention formats
  5. Right points in workflow
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14
Q

What’s the difference between an EMR and EHR?

A

EHR is more encompassing of entire record

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15
Q

What are the 4 main benefits of the EHR?

A
  1. Safety
  2. Access
  3. Efficiency
  4. Communication
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16
Q

What act promotes the use of technology in healthcare?

A

HITECH

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17
Q

What CDS systems are knowledge-based? (4)

A
  1. If-Then logic
  2. Order set
  3. Pop-up
  4. Evidence Button
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18
Q

What CDS systems are active? (2)

A
  1. If-Then Logic
  2. Pop-up
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19
Q

What is true according to rural nursing theory?

A

Rural dwellers closely associate work with health.

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20
Q

What is secondary care?

A

provided by a specialist or agency on referral by a primary

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21
Q

What is tertiary care?

A

specialized consultative care, usually provided on referral from secondary

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22
Q

What is an example of secondary care?

A

An older adult attends older adult daycare 3 days per week

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23
Q

What is an example of tertiary care?

A

A client has OP surgery for cataract removal

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24
Q

What are the requirements of a Critical Access Hospital? (5)

A
  1. rural (35 miles from another hospital)
  2. 24/7 emergency services
  3. at max 25 inpatient beds
  4. reports 96 hours or less as average LOS
  5. may operate rehab/psychiatric care with 10 beds
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25
What is the purpose of Magnet Recognition?
recognize health care organizations that achieve excellence in nursing practice
26
What were the 6 key concepts that define those living in rural areas?
1. work beliefs and health beliefs 2. isolation and distance 3. self-reliance 4. lack of anonymity 5. outsider/insider 6. old-timer/newcomer
27
How far do rural dwellers travel for emergency care?
23 miles
28
How far do rural dwellers travel for routine care?
50 miles
29
What is a mesosystem?
group of microsystems
30
What are the 5Ps of Clinical Microsystems?
1. purpose 2. patients 3. professionals 4. processes 5. patterns
31
How are healthcare systems different from other organizations? (3)
1. purpose 2. specialized workforce 3. public trust
32
What is the focus of the current US healthcare system?
tertiary and secondary healthcare
33
Mission statements often focus on 4 values?
1. research 2. education 3. practice 4. community
34
Effective access requires 3 things?
1. gaining entry 2. transportation 3. trusting a provider
35
Who designated the CAH?
Medicare and Medicaid services
36
What is addressed using capitation?
cost-effectiveness
37
Describe PPOs?
No referral needed to see any provider the patient would like.
38
Describe HMOs?
Coverage is limited to those providers within the organization
39
Describe POS?
requires a referral to see a doctor out of network
40
What is addressed using DRGs?
Cost-effectiveness Efficiency
41
What is addressed using Value Based Purchasing?
cost-effectiveness efficiency value
42
What part of medicare covers a hospital stay for a 70 year old that broke her hip?
Part A
43
What part of medicare covers a blood sugar monitor for a patient?
Part B
44
What part of medicare covers a prescription?
Part D
45
What part of medicare covers a patient that has private insurance which is approved by medicare?
Part C
46
What is a prospective payment system?
reimburses hospitals with a predetermined rate for specific illness
47
What is diagnosis-related groups?
similar patients are categorized into groups that reflect the amount of care provided
48
What is capitation?
a flat payment per covered member regardless of the amount of care provided
49
What is fee-for-service?
providers are paid for each service they perform
50
What are the financing options for U.S. healthcare? (3)
out-of-pocket money taxes insurance premiums
51
Who administers medicare?
federal government
52
Who administers medicaid?
federal and state government
53
Who is eligible for the medicare program? (3)
older than 65 end-stage renal disease amyotrophic lateral sclerosis
54
Who is eligible for the medicaid program (2)?
poor disabled
55
What is the reimbursement rate of medicare? (3)
general revenue payroll taxes beneficiaries' premiums
56
What is the reimbursement rate of medicaid?
state and federal taxes
57
What program isn't the same in each state?
medicaid
58
What has been a disadvantage of DRGs?
increase in readmissions because of being discharged too early
59
According to the ACA, what happens if patients are readmitted within 30days?
fined by medicare
60
What is covered with medicare part A? (4)
1. inpatient hospital 2. inpatient skilled nursing 3. hospice 4. home health
61
What is covered by medicare part B? (5)
1. physician services 2. outpatient care 3. medical equipment 4. home health 5. preventive services
62
What is covered by medicare part C?
Part A & B prescription drug coverage
63
What is covered by medicare part D?
outpatient prescription drugs
64
Which managed care organization allows patients to share costs if they receive services outside of network?
POS
65
What are 3 levels in allocating resources in healthcare?
healthcare vs other needs within the healthcare sector among individual patients
66
Why are healthcare markets more expensive?
costs associated with accessing the good for the consumer
67
With fee-for-service payment is dependent on?
quantity, not quality of service
68
What are the 2 goals of managed care organizations?
reduce costs promote preventative care
69
What are the 3 pros of Capitation?
transparency profit saving resources
70
What is the con of capitation?
depends on patient mix
71
What are the 2 pros of DRGs?
efficiency of care incentives short hospital days
72
What are 2 cons of DRGs?
too early of discharge only seen in hospital settings
73
Who funds pay-for-performance?
Medicare
74
For which patients are accountable care organizations used for?
medicare patients
75
What is the positive outcome of accountable care organizations?
receive part of any saving generated if quality is maintained
76
What do nurse sensitive indicators involve?
structures of care and care processes
77
In part D of medicare there is a coverage gap, how much does the patient pay?
25%
78
Who is tricare for?
military and their families
79
What is the goal of the ACA?
expand health insurance coverage
80
With the ACA, how do people choose insurances?
with state-run health insurance exchanges
81
What are the primary divers of health outcomes (3)?
health behaviors social and economic factors
82
In what 3 ways are health disparities costly?
excess medical care costs lost productivity national economic losses
83
How has expanded medicaid impacted hospitals?
reduces hospitals uncompensated care
84
What are the 2 goals of the patient protection and affordable care act?
provide affordable insurance coverage improve access to primary care
85
How has the removal of the individual mandate impacted insurance premiums?
more sick people (increased)
86
In what case was the individual mandate ruled unconstitutional?
Texas vs Azar
87
What is the latest challenge to the ACA?
don't want to cover preventative costs

Professionalism II (3 decks)

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