Module 10 lecture, part 3

Question 1

Types of access

Answer 1

Potential access
Realized access
Equitable/inequitable access
Effective and efficient access

Question 2

Potential access

Answer 2

HC system characteristics: capacity, organization, financing mechanisms
Enabling characteristics: personal and community resources

Question 3

Realized access

Answer 3

Type: the category of svcs rendered
Site: the place where svcs are received
Purposes of health svcs: the reason medical care was sought

Question 4

Equitable/inequitable access

Answer 4

Equitable access: svcs distributed according to a pt’s perceived need or evaluated need determined by a health professional
Inequitable access: svcs distributed according to enabling characteristics

Question 5

Aspects of effective and efficient access

Answer 5

Links realized access to health outcomes and quality of care

Question 6

What are measurements of access?

Answer 6

Individual level access indicators
Health plan level access indicators
Health care delivery system level access indicators

Question 7

Individual access indicators

Answer 7

Measures of HC utilization relative to enabling and predisposing factors, controlling for need
Pt’s assessment of the interaction with the provider

Question 8

Health plan level access indicators

Answer 8

Plan characteristics that affect enrollment
Plan practices that affect access
Plan quality as measured by HEDIS and pt satisfaction surveys

Question 9

HC delivery system level access indicators

Answer 9

Health policies or programs related access
Physician-population ratio
Hospital bed per 1,000 population
Percentage of population with health insurance coverage

Question 10

Micro view on quality of care

Answer 10

Focuses on svcs at the point of delivery and their subsequent effects
The performance of individual caregivers and HC orgs
Micro dimensions of HC quality
-Clinical (technical aspects)
Interpersonal aspects
QoL: general HRQL, dz-specific HRQL, institution-related QoL

Question 11

Macro view on quality of care

Answer 11

From the standpoint of pops
Reflects the performance of the entire HC delivery system
Evaluates life expectancy, mortality rates, and incidence and prevalence of certain health conditions

Question 12

Quality assessment

Answer 12

Measurement of quality against an established standard
Define how quality is determined, identify specific variables or indicators, collect data, statistical analysis, interpretation
Subjective measures must be quanified
Measurement scales with validity and reliability

Question 13

Quality assurance

Answer 13

The process of institutionalizing quality through ongoing assessment and using the assessment results for continuous quality improvement (CQI)
Based on the principles of total quality management (TQM)
A step beyond quality assessment
Cannot occur without quality assessment

Question 14

Structure in the Donabedian model

Answer 14

Facilities and equipment
Staffing levels and staff qualifications
Delivery system: distribution of hospital beds and physicians

Question 15

Facilities and the Donabedian model

Answer 15

Licensing
Accreditation

Question 16

Staff qualifications and the Donabedian model

Answer 16

Licensure and accreditation
Training

Question 17

Delivery system and the Donabedian model

Answer 17

Distribution of hospital beds and physicians

Question 18

Process and the Donabedian model

Answer 18

Technical aspects of care
Interpersonal aspects of care

Question 19

Technical aspects of care and the Donabedian model

Answer 19

Dx
Tx procedures
Correct prescriptions
Accurate drug administration
Pharmaceutical care
Waiting time
Cost

Question 20

Interpersonal care and the Donabedian model

Answer 20

Communication
Dignity and respect
Compassion and concern

Question 21

Outcome and the Donabedian model

Answer 21

Measured and compared against pre-established benchmarks

Question 22

Final results in the Donabedian model

Answer 22

Pt satisfaction
Health status
Recovery
Improvement
Nosocomial infections
Iatrogenic illnesses
Rehospitalization
Mortality
Incidence and prevalence of dz

Question 23

Initiatives for process improvement

Answer 23

Clinical practice guidelines (medical practice guidelines)
Cost efficiency
Critical pathways
Risk management

Question 24

Clinical practice guidelines

Answer 24

Science-based protocols
To assist practitioners in adopting a best-practice approach
NGC: a comprehensive database of evidence-based clinical practice guidelines and related documents

Question 25

Cost efficiency

Answer 25

Cost efficient when the benefit is greater than the cost
Underutilization and overutilization