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Fundamentals 1 Ati Flashcards > Healthcare Delivery > Flashcards

Healthcare Delivery Flashcards

1
Q

What law was enacted in 2010 to improve healthcare quality while lowering costs and expanding the Medicaid program?

A

Affordable Care Act (ACA)

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2
Q

3 main goals of the ACA?

A

Make health insurance affordable.
Provide protection to people with ACA-funded services.
Expand the Medicaid program to people under 138% of the poverty level.

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3
Q

Sentinel event

A

Adverse event, shouldn’t occur

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4
Q

What org supports nurses to improve client care through education, certifications, and professional designations?

A

The American Nurses Credentialing Center (ANCC)

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5
Q

What program recognizes acute care facilities that demonstrate excellence in nursing based upon meeting standards in five categories?

A

The Magnet Recognition Program

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6
Q

What program is for long-term or outpatient facilities to recognize excellence in nursing?

A

Pathway to Excellence Program

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7
Q

The Magnet Program identifies-

A

Client care excellence
Orgs with quality outcomes
Innovations in professional practice

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8
Q

The Pathway to Excellence Program identifies-

A

Contributions that affect nurses’ well-being
A shared governance structure
A supportive practice environment

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9
Q

What survey tools are designed to evaluate a client’s perception of their experience within the outpatient setting of the healthcare system?

A

Press Ganey & HCAHPS

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10
Q

Press Ganey is administered =

HCAHPS is administered =

A

Press Ganey is administered = After visit

HCAHPS is administered = 48 hr to 6 weeks after visit

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11
Q

Press Ganey is administered to =

HCAHPS is administered to =

A

Press Ganey is administered to = Every client

HCAHPS is administered to = A random sample of clients

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12
Q

Press Ganey is administered by =

HCAHPS is administered by =

A

Press Ganey is administered by = Email

HCAHPS is administered by = Essentially everything other than an email. (Phone call, mail, mail with phone call follow-up, automated voice message)

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13
Q

Press Ganey is evaluating =

HCAHPS is evaluating=

A

Press Ganey is evaluating = Healthcare delivery, client satisfaction

HCAHPS is evaluating= Client satisfaction

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14
Q

Government healthcare coverage for a client who’s 65 or over, under 65 with disabilities, or any age with End Stage Renal Disease (ESRD) =

A

Medicare

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15
Q

What does Medicare consist of?

A

3 separate parts:
Part A = Hospitalizations, skilled nursing facilities, some hospice care, some healthcare
Part B = Dr’s services, physical therapy, occupational therapy, some healthcare
Part D = Prescription drugs

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16
Q

Government healthcare coverage for a client who meets eligibility requirements based on the client’s income in relation to the poverty level =

A

Medicaid

17
Q

Insurance coverage that isn’t provided by a government agency =

A

Private insurance

18
Q

Government healthcare coverage that provides for children who may not meet Medicaid’s requirements but need healthcare coverage =

A

Children’s Health Insurance Program (CHIP)

19
Q

Blue Cross Blue Shield, Aetna, and Cigna are all examples of -

A

Private insurance

20
Q

Government agency that oversees the healthcare delivery of government associated coverage =

A

Centers for Medicare and Medicaid Services (CMS)

21
Q

Fixed payment system for reimbursement for healthcare services based upon client diagnosis and procedures performed =

A

Diagnosis-Related Groups (DRGs)

22
Q

Method of standardized insurance reimbursement based on the client’s diagnosis and procedures performed within the acute care setting =

A

Inpatient Prospective Payment-System (IPPS)

23
Q

Program instituted by the Centers for Medicare & Medicaid (CMS) to increase the quality of care in health care facilities. This program denies reimbursement for services associated with specific HAIs =

A

Hospital-Acquired Condition Reduction Program (HACRP)

24
Q

Fixed payment system for reimbursement of healthcare services provided in the long-term care setting based upon client diagnosis and services required =

A

Resource Utilization Groups (RUGs)

25
Q

Clinical assessment of a client’s physical + cognitive status required to be conducted on nursing home residents who receive Medicare & Medicaid benefits =

A

Minimum Data Set

26
Q

Physical determinants =

A

Physical/ built structures that impact health

27
Q

Social determinants =

A

Social + Community, education, economic stability, health + healthcare, neighborhood + built environment

28
Q

Skilled Nursing Facility (SNF) =

A

Long-term care/ nursing home. May provide short-term care for rehabilitation care like occupational / physical therapy

29
Q

Long-term care hospital (LTCH) =

A

Provides care for stable patients who need a lengthy period of treatment. (Severe burns, trauma, or ventilation needs)

30
Q

Hospice Care =

A

End of life care. Less than 6 months left to live.

Goal = comfort + support services for the client and family, not curative.

31
Q

Palliative Care =

A

Similar to hospice, but not end-of-life care, and patient can still be receiving curative meds

32
Q

Respite Care =

A

Allows the client to be cared for when away from the caregiver for a short period of time. Allows the caregiver to have time for vacations, traveling, etc.

33
Q

Home care can include =

A

Occupational therapy, physical therapy, and social work

34
Q

Case manager =

A

Coordinates the healthcare team in addressing a patient’s needs

35
Q

Social workers =

A

Identify discharge planning solutions and community resources for a patient

36
Q

License Practical Nurse (LPN) =

A

Work under the supervision of the RN to provide basic care to a patient

37
Q

Provider =

A

Prescribes the meds + therapies that patients need to achieve positive health outcomes

38
Q

Occupational Therapists =

A

Assist clients with their ADLs that are due to illness, surgery, or injury

Fundamentals 1 Ati Flashcards (15 decks)

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