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Health Services > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

What are health consequences for the uninsured?

A
  • poorer quality of health, lower rates of preventative care and greater probability of death
  • more likely to receive an initial diagnosis of cancer in a late stage of the disease, poorer treatment outcomes, and to die within less time after diagnosis
  • Less likely to receive timely diagnosis or treatment of STIs; less likely to be aware of HIV status
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2
Q

Uninsured adults are more than ____ percent more likely to die prematurely than adults with health insurance

A

25

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3
Q

Acute of sudden consequences of being uninsured

A
  • Experience poorer medical outcomes following accidents
  • Greater risk of dying while they are in the hospital and for two years after being discharged
  • Those injured in accidents less likely to recover
  • More likely to die from trauma, heart attacks, strokes
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4
Q

Chronic consequences of being uninsured.

A
  • Less likely to schedule regular visits with physicians
  • More likely to suffer from an undiagnosed medical condition that can be controlled with proper management
  • Improvements in people with cardiovascular disease and diabetes in turning 65
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5
Q

Economic consequences of being inunsured

A
  • Medical debt
  • Miss more time from work when ill or injured; retire sooner
  • Being absent means loss of earnings for both employee and employer
  • Employee absence costs employers billions of dollars per year in wages paid to absent employees
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6
Q

Ultimately, people who have insurance also pay for the health care that people who are uninsured receive; this is called

A

hidden health tax

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7
Q

The World Health Organization (WHO) has identified universal health care coverage for adolescents as what?

A

a global health priority

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8
Q

Unmet health care need in adolescence is associated with what?

A

poor health outcomes as an adolescent – and as an adult

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9
Q

Rather than cost, forgo health care for other reasons such as?

A

concern for confidentiality, stigma, and judgmental attitudes among health care providers

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10
Q

Most global research related to adolescent health focuses on what type of approach

A

population-level

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11
Q

Hargreaves and colleagues used an individual-level approach to examine what?

A

whether individual-level factors lead to higher odds of adverse health outcomes

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12
Q

Objective of the National Longitudinal Study of Adolescent to Adult health

A

To estimate the association between unmet health care need in adolescence and 5 self-reported measures of adult health

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13
Q

National Longitudinal Study of Adolescent to Adult health: wave 1

A

Wave I – 1994/1995 (mean age 15.9 years)

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14
Q

National Longitudinal Study of Adolescent to Adult health: Wave IV

A

Wave IV – 2008 (mean age 29.6 years)

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15
Q

National Longitudinal Study of Adolescent to Adult health: dependent variables

A
  • General health
  • Functional impairment
  • Missed any work/school in the last month for health reasons
  • Depressive symptoms
  • Suicidal ideation with the last year
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16
Q

National Longitudinal Study of Adolescent to Adult health: independent variables

A

Unmet health care need

  • Cost
  • Non-financial factors
  • Perceived negative - consequences of accessing care
  • Perceived low importance of the problem
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17
Q

National Longitudinal Study of Adolescent to Adult health: the highest unmet need

A
  1. depressive symptoms

2. missed school/work

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18
Q

Most common reason for unmet healthcare need:

A
  • Perceived low importance
  • Non-financial access problems
  • Negative consequences of health care
  • Cost
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19
Q

Adolescent health outcomes were the strongest predictors of what?

A

adult health outcomes

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20
Q

The odds of adverse adult health outcomes were 13% to 52% higher among subjects who had what?

A

who had reported unmet health care needs in adolescence

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21
Q

Unmet health care need may reflect what?

A

low health literacy/health engagement or other vulnerabilities

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22
Q

Adolescent health are influenced by a wide range of individual, family, peer, and societal factors that go beyond _____

A

health care

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23
Q

Unmet health care need in adolescence is common and is an independent predictor of what?

A

poor adult health

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24
Q

Interventions to improve health care access among adults have limited impact on what?

A

future health and health care costs

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25
Q

Reducing the unmet health care need among adolescents may be a highly effective investment to do what?

A

improve population health outcomes and reduce health care costs

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26
Q

Strategies to reduce unmet health needs

A
  1. Health engagement and care quality
    - early intervention and investment
    - reducing unmet health care need among pregnant women and young children
    - Young people with mental health needs may perceive barriers to accessing care > health care providers should engage and communicate
  2. Cost barriers to accessing services
    - maintain you adults staying on parents’ insurance until the age of 26
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27
Q

Consumer perspective

A

The “price” of health care (physician’s bill, price of prescription, etc.)

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28
Q

National perspective

A

How much a nation spends on health care

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29
Q

national perspective equation

A

Formula: E = P x Q

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30
Q

Provider perspective

A

Cost of producing health care services (salaries, capital costs, rental of space, purchase of supplies)

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31
Q

Health care spending spiraled right after what?

A

the Medicare and Medicaid programs were created in 1965

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32
Q

When was medical inflation brought under control?

A

1990s

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33
Q

Trends in national health expenditures evaluated in 3 ways; what are the 3 ways?

A
  1. Medical inflation to general inflation (annual changes in consumer price index)
  2. Compares change in NHE to those in the gross domestic product (GDP)
  3. International comparisons
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34
Q

Consumer Price Index (CPI):

A

a measure of the average change over
time in the prices paid by urban
consumers for a market basket of consumer goods and services

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35
Q

What are the 3 main sources to assess whether the US spends too much?

A
  1. International comparisons
  2. Rise in health insurance premiums in the private sector
  3. Government health care spending for beneficiaries who receive health care through public insurance programs
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36
Q

Why healthcare costs can be a good thing?

A
  • If E goes up, it means that people are using the healthcare system
  • Means that people have jobs
  • Creates jobs
  • Alleviates suffering
  • Improves lifes
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37
Q

What are reasons for cost escalation?

A
  1. increase in elderly population
  2. continued focus on medical model of healthcare delivery
  3. Defensive medicine
  4. administrative costs
  5. fraud and abuse (upcoding/anti-kickback statute)
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38
Q

What are providers using defensive medicine?

A
  • They do not want to get sued

- Doing way more than they need to be because patient wants them to and to cover their own ass

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39
Q

What are the 6 Dimensions of quality?

A
  1. Safety
  2. Patient centeredness
  3. Effectiveness
  4. Timeliness
  5. Efficiency
  6. Equity
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40
Q

6 Dimensions of quality: Safety

A

Measures complications, falls, medication errors, mortality rates

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41
Q

6 Dimensions of quality: Effectiveness

A

Measures – receiving recommended care for condition

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42
Q

6 Dimensions of quality: patient centeredness

A

Measures – care and service, discharge instructions

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43
Q

6 Dimensions of quality: timeliness

A

dont kno

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44
Q

6 Dimensions of quality: efficiency

A

Measures – utilization of hospital services or procedures measured by discharge rate or average length of stay

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45
Q

6 Dimensions of quality: equirty

A

Measures – accreditation, EMR, nurse-to-patient staffing ratios

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46
Q

What are 7 ways that hospitals can make sure their environment is safe for their patients?

A
  1. Prevent central line-associated blood stream infections
  2. Re-engineer hospital discharges
  3. Prevent venous thromboembolism (VTE)
  4. Limit shift durations for medical residents and other hospital staff
  5. Use good hospital design principles
  6. Build better teams and rapid response systems
  7. Measure your hospital’s patient safety culture
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47
Q

Bipartisan Policy Center - Report: what is it and who funded it

A

Public policy advocacy organization founded by former U.S. Senate Majority Leaders Howard Baker, Tom Daschle, Bob Dole, and George Mitchell

  • Advances the work of the Leaders’ Project on the State of American Health Care
  • Intended to explore policy trade-offs and analyze the major decisions involved in improving health care delivery
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48
Q

Bipartisan Policy Center - Report: mission

A

develop and promote solutions that can attract public support and political momentum

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49
Q

Bipartisan Policy Center - Report: Executive summary

A
  1. Shortfalls in quality and efficiency of care lead to higher costs and poorer health outcomes.
  2. Health care providers do not have the payment support they need to communicate and work together effectively to improve patient care.
  3. Some patients do not receive medically necessary care while other receive care that may be necessary, or even harmful.
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50
Q

Bipartisan Policy Center - Report: framework needed

A

The ability to steadily implement effective reforms in payments, benefits, and regulation to accompany effective reforms in the delivery of care

  • Implementing increasingly sophisticated person-centered measures of quality and cost
  • Concurrently reforming public and private financing and delivery
  • Investing in activities to support coordinated, high-value care in conjunction with payment and benefit reforms
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51
Q

A. Providing Better Performance Measures to Promote Reform and Build Evidence

A

Valid information on the quality and cost of health care, at the level of a patient or episode of care, is widely available and consistently applied

  • Major focus should be on implementation of measures that describe and show ways to address racial, ethnic, and socioeconomic disparities in health care quality
  • Collaborative, multi-payer regional approaches to delivery system reform
  • Consistent use of performance measures
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52
Q

Types of quality measures

A
  1. Structural
  2. Process
  3. outcome
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53
Q

Types of quality measures: Structural

A

Capacity, systems, and processes to provide high-quality care

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54
Q

Types of quality measures: Process

A

What the provider does to maintain or improve health

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55
Q

Types of quality measures: outcome

A

Measures reflect the impact of the health care service or intervention

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56
Q

B. Accountability for Quality Improvement, Cost Reduction, and Value

A
  1. Congress should realign payments by increasing reimbursements for primary care and for other non-physician personnel (case coordination)
  2. Medicare should develop and implement a phased transition from provider reimbursement toward accountability for cost and quality at the population level
    - Payment reform to include shared savings models, bundled payments, partial capitation linked to demonstrated results in improving value (Iowa SIM Model)
    - Accountability payments risk-adjusted to ensure providers and organizations are not penalized for treating higher-risk patients
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57
Q

C. Make Investments to Support Coordinated, High-Value Care

A

Investments needed to provide the infrastructure to support more integrated, higher-value care

  • The American Recovery and Reinvestment Act (2009) – modernize health information technology systems (EMR)
  • Government grants and loans linked to Medicare and Medicaid payments
  • Funds used to promote greater coordination of care and better sharing of clinical information across treatment settings (care coordination models; patient-centered medical home)
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58
Q

D. Encourage regional, multi-stakeholder approaches to reforming health care delivery

A
  1. Developing strategic priorities for delivery reforms – more effective when coordinating with other payers
  2. Bring all public and private payers to the table to promote more consistent measurement, payment, and benefits that support coordinated care
  3. Congress should give Medicare and Medicaid greater authority to participate in multi-stakeholder initiatives
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59
Q

E. Support for Comparative Effectiveness Research

A
  1. Inventory and analysis of existing comparative effectiveness research
  2. The development of priorities for better evidence
  3. Targeting: differentiating the effects of treatments, combinations of treatments, and practices and policies that influence the use of treatments on particular subgroups of patients who may respond differently
  4. More infrastructure investment to gather evidence from actual practice
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60
Q

Executive Summary - Conclusions

A
  1. Clear attributes of different approaches to health care reform that are more likely than others to improve health and slow cost growth
  2. Targeted interventions typically have a greater impact on quality improvement and cost containment than broader approaches
  3. Delivery system reforms are most effective when integrated and ensure accountability from both providers and patients to improve results
  4. Reforms are needed to transition provider reimbursement away from volume and intensity of services toward quality and value
  5. To be most effective, changes in the delivery system and coverage expansions should be implemented together
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61
Q

Quality of Care - AHRQ

A

The Quality Indicators (QIs) are measures of health care quality that use readily available hospital inpatient administrative data. AHRQ develops Quality Indicators to provide health care decision-makers with tools to assess their data.

  • used to highlight potential quality concerns
  • identify areas that need further study and investigation
  • track changes over time
  • in use in acute-care hospitals only
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62
Q

Prevention Quality Indicators

A

A set of measures that can be used with hospital inpatient discharge data to identify quality of care for “ambulatory care sensitive conditions.“

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63
Q

Good outpatient care can prevent the need for what?

A

hospitalizations

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64
Q

Prevention Quality Indicators can provide insight into what?

A

into the community health system

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65
Q

Prevention Quality Indicators is used as what?

A

its used as a “screening tool” to help flag potential health care quality problem areas that need further investigation; provide a quick check on primary care access, and help those interested in improving population health

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66
Q

Inpatient Quality Indicators

A

Provide a perspective on hospital quality of care

  • Inpatient mortality for certain procedures and medical conditions
  • Utilization of procedures for which there are questions of overuse, underuse, and misuse
  • Volume of procedures
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67
Q

Inpatient Quality Indicators: use

A

used to identify potential problems that may need further study

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68
Q

Patient safety indicators

A

Provide information on potential in hospital complications and adverse events

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69
Q

Patient safety indicators was developed after what?

A

comprehensive literature review, analysis of ICD-9-CM codes

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70
Q

Patient safety indicators is reviewed by who?

A

a clinician panel

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71
Q

Patient safety indicators: use

A

used to help hospitals identify potential adverse events

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72
Q

Pediatric Quality Indicators are used with inpatient discharge data to do what?

A

to provide perspective on the quality of pediatric health care

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73
Q

Pediatric Quality Indicators focus on what?

A

Focus on potentially preventable complications and illnesses caused by physician or medication

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74
Q

Pediatric Quality Indicators: use

A

screens for problems that pediatric patients experience as a result of exposure to the health care system

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75
Q

Consumer Assessment of Healthcare Providers and Systems (CAHPS®): when did it begin?

A

Began in 1995 to advance scientific understanding of patient experience with health care

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76
Q

Consumer Assessment of Healthcare Providers and Systems (CAHPS®) conducts research on what?

A

patient experiences and develops surveys that ask consumers and patient to report on, and evaluate, their experiences with health plans, providers, and health care facilities

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77
Q

what are the components of the patient experience model?

A
  1. Providers
  2. health plans
  3. physicians
  4. health care facilities
  • this is not the same as patient satisfaction, its about the actual care you receive. for ex. how the food was, the temp. in the room, etc.*
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78
Q

Publicly reporting the patient experience survey findings help consumers do what?

A

choose among providers and plans

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79
Q

Patient care experience measures are increasingly reported where?

A

in public reporting and pay-for-performance measures

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80
Q

The ACA mandated that CMS establish several public reporting and payment programs, such as what

A

CAHPS®

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81
Q

National survey data indicate that ___ Americans are consulting online rankings and reviews of clinicians; ___ for hospitals and medical facilities

A

1 in 6; 1 in 7

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82
Q

Research – Systematic Review: purpose

A

To gather information on the associations between patient experience measures and other indicators of health care quality

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83
Q

Research – Systematic Review gathered articles from what years, using which search terms?

A

1990-2013, using search terms CAHPS, HCAHPS, and Medicare Hospital Compare

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84
Q

Research – Systematic Review: final results

A

34 studies that met the criteria

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85
Q

Patient Behavior results

A

Better communication, better adherence to treatment regimens; increased trust

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86
Q

Clinical processes results

A

Hospitals with higher HCAHPS scores perform better on process of care for AMI, CHF, pneumonia, and surgery

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87
Q

Clinical outcomes results

A

In AMI patients, better care > better survival after one year after discharge

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88
Q

Efficiency results

A
  • Some aspects of patient-centered care may help to reduce unnecessary health care use
  • Children with asthma who physicians had reviewed a long-term therapeutic plan with parents were less likely to visit the emergency department, make urgent office visits, or be hospitalized
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89
Q

Saftey results

A

Positive patient experiences > lower prevalence of inpatient care complications

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90
Q

Patient experience measures should be collected using what?

A

psychometrically sound instruments; standardization

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91
Q

Measuring patient experiences of care may help to promote what?

A

accountability and quality improvement efforts

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92
Q

Better patient care experiences are associated with what?

A

higher levels of adherence to recommended prevention and treatment processes, clinical outcomes, better patient safety culture, and less health care utilization.

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93
Q

Update on Quality Improvement Efforts: making care safer

A

Half of all patient safety measures improved; significant reduction in adverse drug reactions

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94
Q

Update on Quality Improvement Efforts: each person and family engages in care

A

Nearly all measures improved; better communication

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95
Q

Update on Quality Improvement Efforts: promoting effective communication and care coordination

A

Improved discharged processes and care coordination; increase in the adoption of health information technologies

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96
Q

Update on Quality Improvement Efforts: promoting the most effective and prevention and treatment practices for the leading causes of mortality

A

Half of effective treatment measures improved for life-threatening conditions; increased attention to prevention efforts

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97
Q

Update on Quality Improvement Efforts: Working with communities

A

Half of measures of healthy living improved; increased uptake in adolescent vaccines

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98
Q

Update on Quality Improvement Efforts: Making quality care more affordable

A

affordability has “leveled off”

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99
Q

Only ___ of people with higher BP are receiving the recommended level of care

A

70%

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100
Q

Disparities in hospice care and chronic disease management has _____.

A

increased

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101
Q

across all 6 priorities, disparities still exist according to what factors?

A

income, race and ethnicity

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102
Q

Accessing health services: coverage

A

gain entry into the healthcare system

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103
Q

Accessing health services: services

A

ensure that people have usualy and ongoing source of care

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104
Q

Accessing health services: timeliness

A

provide care quickly after a need is recognized

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105
Q

Healthcare access and utilization compared to 2013:

A

Percentage who had a usual place to go For medical care increased in 2014 for:
Hispanic Adults and
Non-Hispanic White Adults

No significant change for Non-Hispanic, Black and Non-Hispanic Asian Adults

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106
Q

Compared with 2013, the percentage of adults aged 18-64 who had seen or talked to a health care professional in the past 12 months _____ in 2014 for?

Whereas there was no significant change for who?

A

increased; hispanic adults

No significant change for:
Non-Hispanic White adults
Non-Hispanic Black adults
Non-Hispanic Asian adults

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107
Q

Improving access to primary care is about what?

A

maintaining a balance between supply and demand

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108
Q

What does it mean to maintain a balance between supply and demand when talking about improving access to primary care?

A
  • No backlog of appointments

- No delay between when the demand is initiated and the service is delivered

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109
Q

The higher the gap between supple and demand,

A

the increased delay in meeting patient’s needs, more expensive, and increased waste in the health care system

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110
Q

The demand can be predicted accurately based on:

A
  • The population

- The scope of the provider practice; practice style

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111
Q

Institute for Health Care Improvement – Strategies to Improve Primary Care Access

A
  • Balance supply and demand
  • Commit to doing today’s work today
  • Create contingency plans
  • Decrease demand for appointments
  • Do tasks in parallel
  • Find and remove bottlenecks
  • Improve workflow and reduce waste
  • Manage panel size and scope of practice
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112
Q

Match the supply and demand on a ____..

A

daily, weekly, and long-term basis

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113
Q

To balance supply and demand, what is crucial?

A

Communication among departments is crucial

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114
Q

Use the opportunity for communication to actually manage the supply and demand – as well as anticipate and plan for recurring seasonal events such as…?

A

Influenza season
Allergies
Weather-related injuries

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115
Q

To balance supply and demand, what should be apart of a daily schedule?

A

Commit to doing todays work, today
- A system in place to take care of daily demands when the demand is generated (requires strong commitment from health care team)

116
Q

To balance supply and demand, No appointments are “held” or “frozen”; this is to maintain what?

A

flexibility in meeting the daily demand

  • improve patient flow
  • backlog is eliminated
117
Q

Variations in demand

A
  • expected (flu season)

- unexpected (more than usual number of walk-ins)

118
Q

Variations in supply

A
  • vacation

- emergency sick leave leaving lower number of staff

119
Q

Who are often the end product of the mismatch between supply and demand……

A

the patients

120
Q

Contingency Plan: Strategies for Improvement

A
  • establish a policy for late patients
  • develop scripts for common occurrences
  • plan for a sudden absence of a provider or care team member
  • anticipate unexpected increases in demand
  • establish vacation plans and policies
121
Q

Improving access is about increasing the ability of the system to ..?

A

predict and absorb demand

122
Q

Improve access to primary care by reducing the unnecessary demand for various services so the patients that do need the service can…?

A

get it in a timely manner

  • Emergent vs non-emergent care (ER, acute care, primary physician)
  • Specialized care (primary care physician, specialist)
  • Scheduling (longer time between re-checks)
123
Q

Decrease Demand: Strategies for Improvement

A
  1. use alternatives to one-on-one visits
    - group appointments for chronic disease patients
  2. Manage and decrease no-show appointments
    - reminders
  3. increase return intervals
  4. use “max-packing” during the visit
    - address multiple -or anticipated issues- in one visit
124
Q

Parallel processing means what?

A

that the overall process can continue even if one part is delayed
- If a patient provides symptoms of strep throat and provider is delayed, the nurse can perform strep test

125
Q

To do tasks in parallel, what is needed?

A

documentation

126
Q

bottleneck (constraint)

A

anything that restricts the throughput of patients into and through the clinic system

127
Q

bottlenecks (constraint) occur when

A

the demand for a particular resource (e.g., rooms, providers, tests) or part of the system is greater than the available supply (Example: iTriage)

128
Q

Why must the bottlenecks (constraint) be addressed?

A

in order to improve parts of the system

129
Q

“Rate-limiting step”

A

the step that determines the rate at which work passes through the system

130
Q

Improving the flow of work and eliminating waste ensures what?

A

that the clinical office runs as efficiently and effectively as possible.

131
Q

Some reports estimate that up to 40 percentofclinical officework is what?

A

redundant or otherwise wasted effort.

132
Q

Improve Workflow and Remove Waste: changes for improvement

A
  • remove intermediaries
  • use automation and technology
  • move steps in the system closer together
133
Q

Panel size

A

the number of unique patients for whom a care team is responsible; it is a measure of the equity of the work.

134
Q

How can panel size be measured?

A

by calculating the number of unique patients seen by a specific provider within a specific time frame — usually the past eighteen months.

135
Q

The goal to panel size good panel management, meaning what?

A

clinicians and their care teams being responsible to, and caring for, a designated population of patients.

136
Q

Progress on Access to Care, 2013-2016; report released by who, and when?

A

released by the Commonwealth Fund in December 2017

137
Q

Progress on Access to Care, 2013-2016: goal?

A

Compare state trends in access to affordable health care between 2013 and 2016

138
Q

Progress on Access to Care, 2013-2016: methods

A

Analysis of recent data from the U.S. Census Bureau and the Behavior Risk Factor Surveillance System (BRFSS)

139
Q

Progress on Access to Care, 2013-2016: indicators

A
  • uninsured rates for children
  • uninsured rates for working age adults
  • adults access to care
  • percentage of individuals under age 65 with high out-of-pocket medical expenses relative to income
140
Q

for uninsured adults and uninsured children, how many states reported and improvement in the Change in Health Systems Performance, by Access Indicator, 2013-2016

A

Uninsured adults: 47 states reported an improvement

Uninsured children: 33 states reported improvement

141
Q

Adults who went without care due to cost: how many states reported improvement

A

36 states

142
Q

At-risk adults who went without a doctor’s visit in past two years: ___ states reported
Improvement

A

30

143
Q

Dental care: Most states reported what?

A

no change or access to dental care has worsened

144
Q

The rate of uninsured working-age adults dropped where? In 47 states, it fell by at least how much?

A

in all states and D.C; 5 percentage points

145
Q

In nearly three-fourths of states and D.C., the share of adults who went without care because of costs dropped by how much?

A

at least 2 percentage points.

146
Q

The states at the top of the access rankings, as well as those that made the biggest improvements in the rankings between 2013 and 2016, had all what?

A

expanded their Medicaid programs by January 2016

147
Q

The medical home is an approach to primary care that is

A
  1. Person Centered
  2. Coordinated
  3. Accessable
  4. Committed to quality and safety
  5. Comprehensive
148
Q

Defining medical home: Person Centered

A

supports patients and families in managing decisions and care plans

149
Q

Defining medical home: coordinated

A

care is organized across the “medical neighborhood”

150
Q

Defining medical home: accessible

A

care is delivered with short waiting times, 24/7 access and extended in-person hours

151
Q

Defining medical home: committed to quality and safety

A

maximizes the use of health IT, decision support and other tools

152
Q

Defining medical home: comprehensive

A

whole-person care provided by a team

153
Q

The health system transformation requires what?

A
  • public engagement
  • benefit redesign
  • payment reform
  • delivery reform
154
Q

Clear communication and effective coordination among health care providers are vital for patient health, but the current primary care structure makes collaboration what?

A

incredibly difficult

155
Q

PCMHs serves as what for all health and social support services to achieve care coordination

A

a central “hub”

156
Q

PCMH clinical partners

A
  • specialists
  • hospitals
  • home health
  • long term care
  • clinical providers
157
Q

PCMH non-clinical providers

A
  • community centers
  • faith-based organizations
  • schools
  • employers
  • public health agencies
  • YMCAs
  • Meals on wheels
158
Q

Public health transformation requires public engagement, describe what that means.

A

Patients, Families & Caregivers, and Consumers must drive demand for the model

159
Q

One of the most important activities that we engage in at the PCPCC is to what?

A

communicate with the public at large about primary care and the patient centered medical home.

160
Q

Public health transformation requires delivery reform, describe what that means

A

Growing evidence to support that the model works

161
Q

How does PCMH enhances ability to identify and manage high-risk, high-need populations?

A
  1. Risk stratification and diligent monitoring for all patients
  2. Track care plans and medication adherence
  3. Proactive outreach from care team with collaboration among specialists and primary care
  4. Patient engagement and activation
162
Q

What are the components of how the PCMH uses diverse empowered care teams?

A

family, clinical staff, health resources, insurance companies, and a social world are all surrounded around the patients and their needs.

163
Q

How does the PCMH facilitate care that is documented and shared electronically

A
  1. Shared with patients through electronic records, portals, mobile apps, email (which includes patient generated data)
  2. Shared across providers and institutions through health information exchanges
  3. Shared across public and private payers
164
Q

How does PCMH support improved access to care and better patient experience?

A
  1. 24/7 access to care team (phone or e-consults with nurses, etc.)
  2. Alternatives to traditional face-to-face visits, including telemedicine, group visits, e-consults, peer support
  3. Access to electronic health records and patient portals
165
Q

PCMH includes patients, families and caregivers as…?

A

part of a care team

166
Q

For the PCMH, its important to consider experience of care from the _____ – and includes families & caregivers

A

patient’s perspective

167
Q

Patients with multiple chronic conditions (and/or their caregivers) often in best position to advise care team on what?

A

challenges/opportunities to improve care

168
Q

Through their stories, patients can energize and encourage team to promote what?

A

compassionate care

169
Q

How does PCMH include patients, families, and caregivers in practice transformation?

A
  • Invite patients/caregivers into quality improvement efforts from the very beginning
  • Invite patients/caregivers that represent the larger patient population (i.e. ethnicity, culture)
  • Invite patients/caregivers with experience managing their own condition
  • Provide compensation for patients/caregiver advisors
  • Invite more than one patient, family, caregiver
170
Q

Need to integrate behavioral health into primary care: describe the triangle

A

Level 1: Primary care provider (PCP provides first line treatment

Level 2: PCP receives ad-hoc consultation, usually from an off-site mental health specialist

Level 3: PCP supported by brief intervention from on-site behavioral health consultant

Level 4: PCP supported by a collaborative care team with systematic treatment to target

Level 5: Referral to mental health specialty care

171
Q

The health system transformation requires payment reforms, describe this.

A

Necessary to sustain the model and the progress made

172
Q

“Supply side” reforms

A

Reimbursement changes that impact health care delivery

173
Q

Examples of reimbursement changes that impact health care delivery (“Supply side” reforms)

A
  • Increased payment for providers who adopt PCMH model
  • Increased use of shared savings , bundled payments, captivated payments
  • Alignment across all payers through multi-payer or all-payer initiatives
174
Q

“Demand side” reforms

A

Reimbursement changes that impact consumers and employers

175
Q

Examples of reimbursement changes that impact consumers and employers (“Demand side” reforms)

A
  • Consumers pay less in premiums/copays to use higher-value, PCMH services
  • Limit co-pays for wellness visits/primary care
  • Use of tiered pharmacy benefits that encourage the use of cost effective prescriptions (including generics)
  • Improve consumer understanding of the PCMH model and primary care to better manage health
176
Q

Reducing Hospital Readmissions: what is in process

A

reducing costs and improving patient care

177
Q

how many people discharged from the hospital will be readmitted within 30 days or less?

A

15-25% - most are preventable

178
Q

what is a major opportunity for rapid savings in the HC sector?

A

save billions of dollars in healthcare spending

179
Q

Weakness of current efforts in reducing hospital readmissions

A
  • Not data driven, in understanding where readmission problems exist or in determining how well interventions are working
  • Narrowly focused on hospital-based transitions (home, skilled nursing, rehab, assisted living) and not avoiding readmissions
  • Are not supported by payment reforms (such as the State Innovation Model) for physicians, hospitals, and other providers to redesign care to reduce readmissions
180
Q

Hospital Readmissions Reduction Program (HRRP)

A

Section 3025 of the Affordable Care Act added section 1886(q) to the Social Security Act establishing the Hospital Readmissions Reduction Program (HRRP)

181
Q

IPPS

A

inpatient prospective payment system

182
Q

Hospital Readmissions Reduction Program (HRRP) requires CMS to do what?

A

reduce payments to IPPS hospitals with excess readmissions, effective for discharges beginning on October 1, 2012

183
Q

Readmission is defined as what

A

an admission to a hospital within 30 days of discharge from the same or other similar hospital

184
Q

FY 2014 IPPS final rule –

A

added COPD, total hip arthroplasty, total knee arthroplasty

185
Q

FY 2015 IPPS final rule –

A

added coronary artery bypass graft surgery

186
Q

FY 2016 IPPS final rule –

A

added aspiration pneumonia, sepsis patients with pneumonia

187
Q

FY 2018 IPPS final rule –

A

changed the methodology to calculate payment adjustment factor; hospital CEO or designee may submit ECE (extraordinary circumstances extension)

188
Q

Hospital Readmissions Reduction Program (HRRP) adopted readmission measures for the applicable conditions of what?

A

acute myocardial infarction, heart failure, and pneumonia (2012)

189
Q

When calculating the hospital readmission

rate, CMS uses how many years worth of hospital data?

A

three-years

190
Q

Hospitals to incur the largest penalties are those

that have a…

A

1) higher share of low-income

beneficiaries and 2) teaching hospitals

191
Q

A high percentage of patients are

staying in hospitals that scored well on what?

A

on previous measurement period and incurred no penalty or very small penalty

192
Q

National Medicare Readmission Rates started to fall in 2012,
The decline in hospital readmissions due to:

A

Hospital Readmissions Reduction Program

Hospitals making concerted efforts to reduce hospital readmissions before the fines began in 2013

193
Q

IPPS Hospitals

A

Section 1886(d) of the Social Security Act (the Act) sets forth a system of payment for the operating costs of acute carehospitalinpatient stays under Medicare Part A (HospitalInsurance) based on prospectively set rates. This payment system is referred to as theinpatient prospective payment system(IPPS)

194
Q

Under IPPS, each case is categorized into what? explain it

A

into a diagnosis-related group (DRG). Each DRG has a payment weight assigned to it, based on the average resources used to treat Medicare patients in that DRG

195
Q

If the hospital treats a high-percentage of low-income patients, what happens?

A

it receives a percentage add-on payment applied to the DRG-adjusted base payment rate.

196
Q

The disproportionate share hospital (DSH) adjustment

A

provides for a percentage increase in Medicare payments for hospitals that qualify under either of two statutory formulas designed to identify hospitals that serve a disproportionate share of low-income patients.

197
Q

For qualifying hospitals, the amount of The disproportionate share hospital (DSH) adjustment may vary based on what

A

the outcome of the calculation required by law.

198
Q

If the hospital is an approved teaching hospital it receives a percentage add-on payment for each case paid through what

A

IPPS.

199
Q

Direct medical education (DME) adjustment

A

varies depending on the ratio of residents-to-beds under the IPPS for operating costs, and according to the ratio of residents-to-average daily census under the IPPS for capital costs

200
Q

Indirect medical education (IME)

A

residents training in non-provider settings must spend their time in patient care activities in order to be counted. Needed – written agreement between hospital and non-provider setting or hospital pays stipends and fringe benefits of the residents concurrently. (Added on in the ACA)

201
Q

Reducing Readmissions: Step 1

A

Analyze data to identity types and causes of readmissions

  • Readmissions for complications or infections arising directly from the initial hospital stay
  • Readmissions because of poorly managed transitions during discharge
  • Readmissions because of a recurrence of a chronic condition that led to the initial hospitalization (asthma, CHF, COPD)
202
Q

Largest volume of readmissions occur in what patients?

A

patients with chronic diseases

203
Q

Reducing Readmissions: Step 2

A

Reinvent care delivery across the continuum

  • Majority of readmission reduction initiatives have focused narrowly on improving the discharge process or the transition
  • Difficult to try and prevent initial chronic disease admissions, but…..
  • Needs to be a strong focus on improving primary care/outpatient management of patients with chronic disease
204
Q

Reducing Readmissions: Step 3

A

Create payment systems that make care changes sustainable

  • Under Medicaid, Medicare, and most commercial health plans, primary care practices cannot be reimbursed for providing care management services to patients
  • under current payment systems, hospitals lose a significant amount of money when readmissions are reduced, even though they still have to cover the fixed costs of having bed and staff available
  • The approach taken by Medicare and many private health plans is to reduce or eliminate payments to hospitals for readmissions
205
Q

Current procedures for reducing hospital readmissions were based on what

A

the notion that readmissions reflect the quality of care – but may be a result of the discharge process

206
Q

Is it clear what proportion of the readmissions are truly preventable?

A

no - unclear

207
Q

Hospital readmission rates are not meaningfully related to what

A

other performance measures of hospital quality

208
Q

Academic institutions and hospitals in socioeconomically ____ areas are disproportionately affected

A

disadvantaged

209
Q

Interventions - Hospital to Home –> types of interventions

A
  • patient education
  • discharge planning procedures
  • follow-up telephone call
  • patient centered discharge instructions
  • discharged coaches/nursed interacting with patient before and after discharge
210
Q

Interventions - Hospital to Home: findings

A

single interventions unlikely to work but multi-faceted interventions are likely to necessary for substantial improvements in readmission rates

211
Q

Interventions – Hospital to Post-Acute: Settings

A

Skilled nursing or rehabilitation facilities

212
Q

Interventions – Hospital to Post-Acute: population

A

This population accounts for a substantial portion of overall and disease-specific hospital readmissions (CHF, pneumonia, co-morbidities)

213
Q

Interventions – Hospital to Post-Acute: how should prevention steps occur and what should they include attention to

A

early in acute hospital stay and include attention to

  • medical reconciliation
  • minimize use of urinary catheters, PICC lines and other in-dwelling devices
  • include patients in advanced-care planning discussions
214
Q

When the hospital does not have the capacity to use a multi-faceted approach for all patients, how should they identify those who are more likely to be readmitted?

A

identify those at high risk of readmission

- use of readmission risk prediction models

215
Q

When identifying high risk patients for readmission, how should the readmission risk score be calculated?

A

early enough during index hospitalization to allow time for intervention
- Tailor prediction models to specific patient population or disease

216
Q

What are potential new frontiers for identifying high risk patients for readmission?

A
  1. Telemonitoring for disease management
  2. Incorporate behavioral therapy in the hospital, during home visits, and ambulatory care setting
  3. Enhance the discharge process
  4. Community partnerships
  5. Create new roles in the health care team such as transition coaches, discharge advocates, and transition care coordinators
217
Q

Technology has played a role in medical cost ___

A

inflation

218
Q

Technology has done with with consumer expectations?

A

raised

219
Q

Technology has led to what in specialized medicine

A

led to increases

220
Q

Technology and ethics: describe

A

Technology has raised complex social ethical concerns

221
Q

What is medical technology?

A

The practical application of the scientific body of knowledge for the purpose of improving health and creating efficiencies in health care

222
Q

Physics: how has it impacted medical technology?

A

(x-ray technology, mammography, ultrasound, MRI)

223
Q

Chemistry: how has it impacted medical technology?

A

drug development

224
Q

Computer science and communication technologies: how has it impacted medical technology?

A

telemedicine

225
Q

Bioengineering: how has it impacted medical technology?

A

robotic systems in surgery; advanced prosthesis

226
Q

Medical Technology: Diagnostic

- give ex.

A

Computed Tomography, Fetal Monitor

227
Q

Medical Technology: survival

- give ex.

A

ICU, Bone Marrow Transplant, CPR

228
Q

Medical Technology: illness management

- give ex.

A

renal dialysis, pacemaker

229
Q

Medical Technology: cure

- give ex.

A

hip joint replacement, lithotripter

230
Q

Medical Technology: prevention

- give ex.

A

Vaccines, Cardioverter defibrillator Implant

231
Q

Medical Technology: facilities and clinical settings

- give ex.

A

Hospital Satellite Centers, Clinical labs

232
Q

IT Applications: Clinical Information Systems

A

Process, storage and retrieval of information to support patient care delivery

233
Q

IT Applications: Administrative Information Systems

A

Carry out financial and administrative support activities

234
Q

IT Applications: Decision Report Systems

A

Information and analytical tools to support managerial and clinical decision making

235
Q

Health Care Informatics: Defined

A

“the integration of health care sciences, computer science, information science, and cognitive science to assist in the management of health care information.”

236
Q

Describe how Health Care Informatics and nursing have turned out

A

vastly growing field

237
Q

Health Care Informatics: outcomes

A

enhanced delivery of care, improved health outcomes, and advanced patient education

238
Q

Health care informatics help to bridge the gap between

A

technology, workflow, and the data collection process

239
Q

American Recovery and Reinvestment Act (ARRA) 2009

A

Health Information and Technology for Economic Clinical Health Act (HITECH)

Clinics and hospitals are rewarded for using EHR – penalizes them if not being adopted in the near future

Massive amount of data to be managed and analyzed

240
Q

Policy makers can use the information contained in the EHR to

A

inform decision making about public health issues

241
Q

Electronic Health Record (EHR) =

A

“systematic electronic collection of health information about patients”

242
Q

Four Key Components of EHR

A
  1. Collection and storage of health information on individual patients over time
  2. Immediate electronic access to person- and population-level information by authorized users
  3. Availability of knowledge and decision support
  4. Support of efficient processes for health care delivery
243
Q

EHR benefits

A
  1. Major savings in health care costs
  2. Reduced medical errors
  3. Improved health
  4. Improved quality of care, timeliness, adherence to clinical practice guidelines, and reduce medication errors
244
Q

EHR Drawbacks

A
  1. Changed the emphasis from patient-centeredness to institutional priorities
  2. Increased time and effort required in documentation
  3. expensive start-up costs
245
Q

Smart Card Technology

A

Pocket-size smart card embedded with a microchip to allow hospitals and physicians’ offices to access personal medical information

246
Q

Smart Card Technology adoption rate

A

very slow

247
Q

Why does the public view smart cards with suspicion and distrust

A

Information security

Personal privacy

248
Q

Internet application in the medical world

A

a. First source of information that patients consult for specific health conditions (70 percent)
b. Physician consultations; online support communities

249
Q

E-Health

A

electronic health care; secure patient portals

250
Q

M-Health

A

mobile health; wireless communication devices to support clinic practice; most common use is for EHR access

251
Q

E-Therapy

A

behavioral support and counseling

252
Q

Virtual Physician visits

A

online encounter between patient and physician

253
Q

Cost effective method to deliver patient care and expand access

A

telehealth

254
Q

Connects patients to virtual health care services through videoconferencing and need for reimbursement

A

telehealth

255
Q

Medicare lagging behind private insurers for understanding the importance and need for reimbursement

A

telehealth

256
Q

Information regarding the benefits of telehealth need to be conveyed to policy makers to support what

A

incorporation into health care delivery

257
Q

Interventions – Chronic Disease Management: Congestive Heart Failure

A

noticeable health improvements, fewer episodes of worsening care, and general improvement in clinical, functional, and quality of life status

  • reduction in mortality
  • Reduced hospital admissions, re-admissions, length of stay, and emergency department visits
258
Q

Chronic Disease Management of Congestive Heart Failure improves access to what

A

stroke specialists in medically underserved areas

259
Q

In 2016, approximately
___of hospitals are
currently using or implementing
telehealth

A

65%

260
Q

Barriers to wide adoption of telemedicine

A
  • medicare limits coverage and payment for telehealth services
  • limited access to broadband services (esp. rural facilities)
  • challenges of cross state licensure
  • Credentialing and privileging, online prescribing, privacy and security, and fraud and abuse
261
Q

Factors that Drive Innovation & Diffusion: Anthro-Cultural Beliefs and Values

A

Americans want to be the “best”, reliance on medical model of care

262
Q

Factors that Drive Innovation & Diffusion: Medical Specializaiton

A

broad exposure to technology for specialty residency training programs

263
Q

Factors that Drive Innovation & Diffusion: financing and payment

A

limits on payments to hospitals for the use of high-tech procedures

264
Q

Factors that Drive Innovation & Diffusion: Technology-Driven Competition

A

Insured patients are more likely to seek services from hospitals with “state of the art” equipment

265
Q

The Impact of Medical Technology: Quality of care

A

Precise medical diagnoses, quicker and more complete cures, reduce risks

266
Q

The Impact of Medical Technology: Quality of life

A

Long-term maintenance therapies, pharmaceutical breakthroughs, pain management

267
Q

The Impact of Medical Technology: Health Care Costs

A

Accounted for roughly half of the total rise in health care spending

268
Q

The Impact of Medical Technology: Access

A

Mobile equipment can be transported to rural and remote sites

269
Q

The Impact of Medical Technology: Structure and processes of health care delivery

A

Medical centers, alternate settings, IT systems, telecommunications

270
Q

The Impact of Medical Technology: Global medical practice

A

Medical device companies based in the U.S. exporting to other countries

271
Q

The Impact of Medical Technology: bioethics

A

Does medical technology benefit everyone? Who has access?

272
Q

National Partnership for Women & Families

A

National, non-profit, consumer organization with 40 years’ experience working on issues
important to women and families

273
Q

Campaign for better care

A

Engage patients and consumers in re-design of our health care delivery and payment
system

274
Q

Institute of Medicine

A

Care that is respectful of and responsive to individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions.

275
Q

Planetree

A

An approach to the planning, delivery and evaluation of care grounded in mutually beneficial partnerships among providers, patients and families. It redefines relationships in health car

276
Q

Whole person care

A

clinicians understand the full range of factors affecting a patient’s ability to get and stay well

treatment recommendations align with patients’ values, life circumstances and preferences

277
Q

Coordination and communication

A

providers organized in teams and smooth transitions between settings

278
Q

Patient support and empowerment

A

expanding patients’ and caregivers’ capacity to get and stay well and support for self- management tools and services

279
Q

Ready Access

A

getting appointments promptly and accommodating barriers such as language or physical or cognitive problems

280
Q

what will happen to the proportion of the worlds population from 2015 2050

A

the proportion of the worlds population over 60 years will nearly double from 12% to 22%

281
Q

mental and neurological disorders among older adults account for how much of the total disability for geriatrics

A

6.6%

282
Q

about what percent of people 55 years or older experience some type of mental health concern?

A

20%

283
Q

The most common conditions for geriatrics include

A
  • anxiety
  • severe cognitive impairment
  • mood disorders such as depression or bipolar disorder
284
Q

what are often implicated as a factor in cases of suicide

A

mental health issues

285
Q

who has the highest suicide rate of any age group

A

older men

286
Q

what is required by the department of human services (state of iowa) to provide psych services to individuals they deem in need (PASRR)

A

SNF/ICF

Health Services (2 decks)

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