Health Professionals and Institutions (wk 9) Flashcards
List the requirements of attaining a health care credential
Meet admission criteria
Successful completion of coursework requirements
Education (pursing a degree or certificate)
Training (rotations, residency, etc.)
Demonstrate competency through examinations (PANCE/PANRE)
Official Recognition of Educational Program (ARC-PA)
Registry, certification, and/or licensure.
You get your PA degree, then you get your ____________, then finally your _________________.
certification; license
What are the 2 main types of health professionals?
1) Clinical
2) Allied
Give examples of clinical health professionals
MDs/DOs, nurses, dentists, pharmacists, PAs, NPs, optometrists, clinical psychologists, and others
List and give examples of the 2 different types of allied health jobs
1) Graduate-level trained: physical therapists, occupational therapists, and medical social workers
2) Associate’s degree trained: dental assistants, sonographers, and laboratory technicians
1) Who accredits PA programs?
2) Who is the national PA certifying body?
3) Who gives our licenses?
1) ARC-PA
2) NCCPA
3) Individual state
Define accreditation and give an example
A process that evaluates institutions
Sets standards for educational and training institutions and enforces these standards
How?
Through a regularly scheduled institutional self-study and an outside review
Example:
The accrediting body for PA education is the ARC-PA (Accreditation Review Commission for Education of the Physician Assistant)
What is the goal of the accreditation process?
continuously evaluate and improve their processes and outcomes
helps prospective students identify ideal programs
protects programs from internal and external pressures to make changes
involves faculty and staff in comprehensive program evaluation and planning
stimulates self-improvement by setting national standards
Licensure is required to practice as a specific healthcare provider; what are some requirements?
Local residency requirements
A criminal background check
Continuing education requirements
Describe credentialing
Individual evaluation
Individual qualifications to practice in a profession
Often takes the form of a Certification such as through a formal exam
Defines specialties and subspecialties within a profession
i.e. “board-certified”, PA-C
Welch-Rose Report (1915):
1) What did it help develop + establish?
2) What did it establish?
3) What occurred in the 1970s-80s?
1) Schools of public health at the graduate level for nurses, engineers, physicians, etc.
2) Johns Hopkins University was established as first graduate school of public health (1916)
3) Growth of schools of public health and more programs in public health
Describe the Educational Options within Public Health
Masters of Public Health (MPH)
Generalist core
Specialties within MPH:
epidemiology, biostatistics, environmental health, health administration, health policy, etc.
Growth of doctoral programs (PhD, DrPH)
Describe the result of the Community College and Public Health Report (2014)
Encouraged public health education at the community college level
Health Navigation education
Recommended by the Report
Certificate program vs associate degree to help individuals navigate the complex public health, healthcare, and health insurance systems
Example: community health worker, patient navigator, health insurance navigator
~500,000 public health professionals in the US
Formal Public Health accreditation of public health schools and programs by Council on Education for Public Health (CEPH)
Career opportunities:
Governmental public health
Not-for-profit and for-profit institutions
Educational and healthcare institutions
National Board of Public Health Examiners
Certification in Public Health (CPH) exam
+ maintenance of certification programs
CPH exam eligibility:
Enrolled in or completed a Council on Education in Public Health accredited Master’s program OR completed an undergraduate degree and have relevant public health experience
Certification is voluntary but increasingly expected
1) National Board of Public Health Examiners offers what?
2) Who is eligible?
3) Is this voluntary?
Certification in Public Health (CPH) exam
+ maintenance of certification programs
CPH exam eligibility:
Enrolled in or completed a Council on Education in Public Health accredited Master’s program OR completed an undergraduate degree and have relevant public health experience
Certification is voluntary but increasingly expected
1) Differentiate Allopathic (MD) vs Osteopathic (DO)
2) Describe the different recent changes
1) 35+ osteopathic schools
150+ allopathic schools
Graduates apply and compete for the same residency and fellowship programs
2) Hospice and palliative care recently added
Subspecialty certification for hospitalists (peds and adults)
Increasing diversity of trainees
USMLE Step 1 now P/F
Customize curricula
Describe the results of the 1910 Flexnor Report
1) Formalized science-based medical education, hospital-based clinical rotations and a 4-year education model
2) Flexnor era of US Medicine extended until the 1980s (longer for some institutions) led to…
a) Growth and dominance of specialties and specialists
b) Hospital-based residency programs
c) Fellowships leading to specialty and subspecialty training
1) Changes in medical education began in the mid ______________
2) Why?
1) mid-1980s
2) Much healthcare moved out of hospitals
-Increased medical school enrollment of women and minorities
-A broader view of what should be included in medical education
-A better understanding of how learning takes place
What caused changes in the medical education to begin in the 80s?
Encouragement of a wider range of undergrad majors
Courses in behavioral and social sciences encouraged
Changes to the MCAT
Increased use of PBL; new curriculum added in EBM, interviewing skills, and ethics
OSCEs (OSLERs)
Primary care experiences/rotations outside of the hospital
Move towards continued specialization with fellowships
Limits of residency training (80hrs/week or <24 consecutive hours)
Describe the Doctorate of Nursing Practice (DNP) role
1) Tend to specialize (FNP/NA/PNP/AGPCNP/Midwife/Women’s Health/Acute Care)
2) 433 DNP programs in the US
Describe Registered Nurses (RN) briefly
1) Hospital-based services
2) Requires a state license (may require a BSN)
List the New and Expanding Roles for Nurses
Infection control specialists
Health navigation
Nurse Case Management
Patient safety
Health Information Systems
Disaster and emergency management
New/ expanding nurse roles; describe:
1) Health navigation
2) Nurse Case Management
1) Help patients navigate the increasingly complex healthcare system, insurance, etc.
2) Work in hospitals to ensure timely services, communications between healthcare professionals, and to expedite transitions to home or follow-up health facilities
True or false: Until the 1960s-1970s, the MPH degree was aimed at physicians and nurses
True
Compensation depends on what?
1) Site where care is delivered (Primary vs Secondary vs Tertiary)
2) The patient’s insurance
-Example: Medicare covers services that PAs provide at 85% of the physician fee when billed under the PAs NPI number.
3) Type of institution in which the professional works or is employed
-Clinical setting plays a significant role
List and describe areas of Shortages of Healthcare Professionals in the US
1) Primary Care Physicians (FM, IM, Ob-Gyn)
2) Dentists: Dental schools closed in the 1980s when there was an oversupply; now, a shortage.
3) Nursing (~3 million RNs in US today): 1 in every 3 RN program applicants is turned down
-Now, expected deficit
List, describe, and give examples of the 2 main kinds of healthcare institutions
1) Outpatient Facilities
-Clinical services
-Diagnostic testing or treatment (Quest labs, outpatient surgery centers, etc)
2) Inpatient Facilities (>24hrs)
-Hospitals
-Long term care facilities
-Skilled nursing and rehab facilities
-Nursing homes
-Institutional hospices
Describe common features of all hospitals
1) Licensed by the state and usually accredited by a national organization (ie The Joint Commission)
2) An organized physician staff (“house staff”) and 24/7/365 nursing services
3) Governing board separate from the medical and nursing staff responsible for operating the hospital consistent with state and federal laws
List and describe the 3 main types of non-profit hospitals
1) Private nonprofit
½ of the 6000 hospitals
Many affiliated with religious denominations
2) State, local, or federal government-owned
20% of the 6000 hospitals (community hospitals)
Federal: VA hospitals and military hospital system
3) Run by institutions/universities
Teaching vs nonteaching hospitals
Academic health center
Example of Non-profit hospital system:
Department of Veteran Affairs (VA)
Safety net for veterans who may not have other sources of medical care
Funding
As of 2019, VA enrollees can obtain medical care outside the VA system if their wait for the VA exceeds 14 days (previously 30) AND the VA will cover the costs
Describe For-profit Hospitals
Balance community service with shareholder returns
More financial pressure (especially if a publicly traded company)
20% of all hospitals
Highest number in Florida, Nevada and Texas
Small number of large corporations specializing in providing healthcare services
Example: HCA (based in Nashville)
Often more expensive than nonprofit
Usually located in areas with more under or uninsured patients
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Nursing homes
16,000 nursing homes in the US with 1.5million residents
Long-term or custodial care of patients unable to perform activities of daily living (ADLs)
Regulations:
State nursing home regulations
Federal minimal standards
Assisted living and dementia care
Not recognized as healthcare facilities
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Skilled nursing facilities (SNF)
Generally short-term, aimed at accomplishing specific objectives
Examples: recovery after a stroke, recovery after a hip fracture and surgery
2) Hospice care
Life expectancy of <6mos
Paid for by Medicare
Provides comfort, palliation, and emotional support
Clinical facilities
Example: Provider clinics
Example: Community Health Centers
Health Centers Consolidation Act of 1996
Combined community health centers with healthcare services for migrants, the homeless, and residents of public housing to consolidate (aka 330 grantees)
Diagnostic testing
Example: Outpatient radiology
Therapeutic facilities
Example: PT, OT
Quality can be assessed by the structure, process, and outcome measures; describe each
Structure
the physical and organizational infrastructure in which care is delivered.
Process
the procedures and formal processes that go into delivering care
Example: credentialing process for healthcare professionals
Outcome measures
refer to a focus on the result of the care provided
National Committee for Quality Assurance (NCQA)
National Committee for Quality Assurance (NCQA)
Developed a general framework to assist with defining and measuring quality
Coordination and integration of healthcare delivery are key to the efficiency and quality of care provided.
NCQA medical care report cards
Efforts to integrate the healthcare system include what? Describe
Integrated healthcare delivery systems
A coordinated and collaborative network that links various healthcare providers
The use of integrated EMRs
Connection of EMR platforms to enable smooth flow of communication and coordination of clinical information and data
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Coordination sought between institutions and settings
Goal to formally link institutions, services, and information (requires financial coordination)
Example: insurance coverage of services in one setting but not in another reflects ineffectiveness and inefficiency in the system
Coordination between healthcare delivery and public health functions
Example: communicable disease control (controlling antibiotic resistance) and environmental protections (lead exposure)
Describe care coordination in emergencies
Emergency response system is an example of a care coordination success.
Helps to quickly respond to emergencies.
Provides onsite assistance and information.
Identifies the healthcare institution that is best prepared to handle the emergency
Patient Safety Movement
To Err is Human: Building a Safer Health System Report (2000)
~100,000 deaths per year in hospitals = the result of errors
Individual errors
Systems errors
Focus shifted from errors (individual) to safety (system)
“A culture of safety”
Built on trust, accountability, and transparency
Benefits:
Limited legal liability
Investigating recovery patterns for improvement
Steps needed to build a culture of safety:
- Leadership
Transformational leadership - Transparency
Within and outside the organization - Errors
If a medical error, apologize, pay for all care, seek resolution, and provide continued care - Near-misses/Good catches
Creation of a reliable means to capture and analyze good catches/near-misses - Continual assessment
Describe medical malpractice
Varies state to state
Part of the civil law so cases decided by jury based on preponderance of the evidence
Builds on negligence law intended to protect an individual from harm
Considered medical malpractice only if the patient can establish all four of the following…
A duty was owed
A duty was breached
The breach caused injury
Damages occurred
Keystone ICU project
Instituted in 2004 in 103 Michigan ICUs
Goal:
Prevent some of the 80,000 catheter-associated bloodstream infections and 28,000 deaths associated with these infections in the US yearly
Intervention:
A short checklist of best practices related to catheter use
Outcome:
Incidence dropped to <20% of previous infections
