Module 11 lecture, part 3 Flashcards
Implementing community-oriented primary care
Primary care must take a central place in the delivery of health svcs
Biomedical model must be broadened to include a stronger element of social and behavioral sciences
Primary care should include primary, secondary, and tertiary prevention
PH functions must be strengthened as an adjunct to clinical interventions
Lessons from the Vermont Blueprint
A pilot program launched in 2006
Shifted to a statewide program after the passage of the ACA
Integration of medical home and COPC models
Medical homes supported by community health teams and an integrated IT infrastructure
Community health teams offer individual care coordination, health and wellness coaching, and behavioral health counseling for a defined pop
Reduced ED use and hospitalizations are necessary for financial viability
The role of pt activation
More informed and engaged consumers leads to positive effects on utilization, costs, and outcomes
Definition of pt activation
A person’s ability to manage his or her own health and utilization of HC
-Needs individual knowledge, skills, and motivation to make decisions in partnership with HC providers
-Needs changes in one’s own health promoting behaviors
Pt activation and SES
Considerable difference in activation levels across socioeconomic and health status characteristics
-Lowest among Medicaid enrollees
What was identified as the main element of high-quality care by the IOM in 2001?
Patient-centered care
Definition of pt-centered care
Respecting and responding to pts’ wants, needs, and preferences, so that they can make choices in their care that best fit their individual circumstances
The role of pt-centered care
Promotes pt activation
Positive impact on pt satisfaction, adherence to tx regimens, and self management of chronic conditions
What is the Roter Interaction Analysis System (RIAS) used for?
Evaluate physician-pt interactions
Train physicians in pt-centered communication
Recommendations for the nursing profession (IOM, 2016)
Practice to the full extent of their education and training
Obtain higher levels of education and training
Achieve cultural diversity in the nursing workforce
Collaborate to work to their full potential
Better data and improved information systems
Training of PCPs
Expertise in:
Anticipating, preventing, and managing complex conditions
Managing complex pharmacology
Understanding end-of-life issues and ethics
Coordinating care
Leading HC teams
Training in geriatrics
Critical shortage and worse shortage expected in the future
Better outcomes by geriatric professionals without cost increases
Recommendations (IOM, 2008): residency training, better recruitment and retention, and financial incentives for specialists, better pay and benefits for direct care workers in geriatric settings
Six areas of concern in LTC
Financing: reform needed in both public and private financing
Resources
Infrastructure
Workforce: a deficit of direct care workers is projected
Regulation
Information tech: interoperable IT systems are needed
Resources and LTC concerns
Home and community based services waiver program moved pts out of nursing homes to community based care
HCBS not successful in reducing Medicaid spending
Infrastructure and LTC concerns
Models of cultural change
Care coordination and transitioning
Single point of entry into the LTC system
