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Certified Medical Assistant > Module 14: Patient Care Coordination and Education > Flashcards

Module 14: Patient Care Coordination and Education Flashcards

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USMLE® Step 1 flashcards
1
Q

what contributes to the increase in healthcare costs

A
  • lack of care coordination
  • repeated diagnostic testing, multiple prescriptions, adverse medication interactions, unnecessary emergency department visits, hospital readmissions
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2
Q

care coordination

A

deliberate organization of pt care activities between two or more participants involved in a patient’s care to facilitate the appropriate delivery of healthcare services

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3
Q

Affordable Care Act (ACA)

A
  • signed 2010
  • increased quality, availability, and affordability of private and public health insurance
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4
Q

are chronic illnesses increases

A
  • yes
  • expected increase of over 1 percent each year
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5
Q

patient-centered medical home (PCMH)

A
  • pt is focus
  • use holistic healthcare approach
  • intended to improve effectiveness of primary care
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6
Q

accountable care organization (ACO)

A
  • pt is focus
  • use holistic healthcare approach
  • association of providers and third-party payers that assume responsibilities for specific populations and held accountable financially and quality-wise for members’ health
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7
Q

holistic health care

A
  • comprehensive
  • considers physical, emotional, social, economic, and spiritual needs of person
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8
Q

primary care provider (PCP)

A
  • first provider pt seeks care from
  • preventative care services
  • can be family practitioners, internal medicine, doctors of osteopathy, pediatricians
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9
Q

specialist

A
  • provider that diagnoses and treats conditions that require specific area of expertise
  • pt referred to by PCP
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10
Q

physician assistant (PA)

A
  • similar to physicians
  • license to practice medicine when supervised by MD
  • conduct physical exams, provide preventative care, prescribe diagnostic tests, assist with surgical procedures, diagnose illnesses, prescribe medicine
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11
Q

advanced practice nurses

A
  • more education and experience than RN
  • similar tasks as PA
  • clinical nurse specialist, nurse anesthetist, nurse practitioner, nurse midwife
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12
Q

registered nurse (RN)

A
  • licensed by state
  • associate or bachelors in nursing
  • oversee case management of pt with chronic conditions
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13
Q

practical nurse (PN)

A
  • vocational nurse
  • licensed by state
  • 1 yr training
  • triage phone calls, administer meds, assist with clinical duties
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14
Q

pharmacist

A
  • prepare and dispense medications
  • knowledgeable on meds and combos
  • educate pts
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15
Q

dentist

A
  • diagnose and treat teeth and mouth issues
  • educate on disease prevention of mouth
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16
Q

occupational therapist

A
  • assist and educate pt on performing tasks after [physical, mental, or developmental disability
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17
Q

physical therapist

A
  • assess pt pain, strength, mobility
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18
Q

speech therapist

A
  • pts having problems with speech and swallowing due to injury, cancer, or stroke
  • work toward improving, regaining, and maintaining ability to communicate, chew, and swallow
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19
Q

psychiatrist

A
  • MD who diagnose, prescribe, and treat mental, behavioral, and emotional disorders
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20
Q

psychologist

A
  • not MD
  • doctor of psychology or philosophy
  • work with pts having mental health challenges
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21
Q

social workers

A
  • assist pt and families in times of transition or crisis
  • clinical or hospital setting
  • physical, emotional, and financial issues related to injury or illness
  • coordinate additional services (transport, housing, meals, financial resources, hospice)
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22
Q

registered dietician nutritionist (RDN)

A
  • expert in diet and nutrition
  • educate pt on connection between chronic disease and poor nutrition
  • assist with meal planning
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23
Q

examples of support staff

A
  • clinic coordinator
  • medical administrative assistant
  • clinical medical assistant
  • medical records specialist
  • medical billing specialist
  • financial counselor
  • scheduler
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24
Q

key to achieving full participation of pt and their families

A

good communication

25
Q

successful care coordination results in what

A
  • improved pt outcome
  • increased pt satisfaction with care
  • fewer hospitalizations
  • less testing
  • fewer treatments
  • decreased healthcare costs
26
Q

Institute for Health Care Improvement (IHI) goals

A
  • aka triple aim initiative
  • improve experience of care
  • improve health of populations
  • reduce costs of healthcare
27
Q

ACA goals

A
  • expand health insurance coverage
  • shift focus of healthcare delivery system from treatment to prevention
  • reduce costs and improve efficiency of healthcare
28
Q

five core functions of PCMH

A
  • comprehensive care: cares for all pts needs
  • patient-centered: pt and family are core members of team
  • coordinated care: all services are overseen by provider-directed medical practice
  • accessible services: provide tools through pt portal
  • quality and safety: evidence-based medicine
29
Q

how to PCMH save money

A
  • reducing emergency department visits and hospital admissions/readmissions
  • provide overall improvement in pt health
30
Q

how is ACO different from PCMH

A
  • ACO includes many practices within one organizing entity (many providers, hospitals, specialty clinics)
  • ACO focused on more than the pts in one practice, relationship to community
  • ACO emphasis on public health issues to prevent illness
  • ACO may have outreach programs available to anyone
31
Q

successful transitional care

A
  • appropriate coordination and continued quality in healthcare as patient moves from one care setting to another
  • communication between providers
32
Q

nurse in transitional care model

A
  • communicates with provider’s office
  • accompanies pt to follow-up visits
  • educates pt on managing their own care
  • encourages pt to take active role in maintaining health
33
Q

when does planning for pt discharge begin

A
  • upon admission to critical care facility
34
Q

what should you make sure is available to the provider before a scheduled appointment

A
  • all reports from the hospital stay
35
Q

what should each workday start with

A
  • team meeting to go over pt list for the day
36
Q

determinants of health

A
  • social factors
  • health services
  • individual behaviors
  • genetic factors
  • accessibility and affordability of care
  • policymaking
37
Q

conditions that have strong biological or genetic connections

A
  • sickle cell anemia
  • hemophilia
  • cystic fibrosis
  • heart disease
  • cancer
38
Q

social determinants

A
  • education
  • employment opportunities
  • fresh foods in grocery stores
  • minimal exposure to crime and violence
  • adequate transportation
  • exposure to mass media/emerging technologies
39
Q

physical determinants

A
  • weather/climate change
  • housing/neighborhoods
  • work sites
  • recreational settings
  • exposure to toxic substances and physical hazards
40
Q

Medicare Access and CHIP Reauthorization Act (MACRA)

A
  • April 16, 2015
  • replaces Medicare reimbursement schedule with pay-for-performance prgam
41
Q

two new payment tracks available through MACRA

A
  • Merit-Based Incentive Payment System (MIPS)
  • Advanced Alternative Payment Models (APM)
  • determine what Medicare will reimburse providers
42
Q

four performance categories for Medicare reimbursement

A
  • quality
  • cost/resource use
  • clinical practice improvement activities
  • advancing care information
43
Q

areas tracked by MACRA

A
  • using claims data to calculate population-based measures
  • promotion of EHR use
  • achieving health equity
  • expanded practice access
44
Q

things to establish in pt chart during pre-visit planning

A
  • due dates of preventative testing
  • due dates of immunizations
  • due dates of pt care management items
  • expired or soon-to-be-expired prescriptions
45
Q

CMA responsibilities during visit

A
  • escort to exam room
  • get ht and wt
  • vitals
  • pt intake questions
  • medication reconciliation
  • documenting
  • discuss diagnosis or treatment with pt
46
Q

how to achieve pt compliance

A
  • develop rapport with pt to make them feel involved
  • effective communication
  • establish trust
47
Q

auditory learning

A
  • hearing info
  • provide info verbally
48
Q

kinesthetic learning

A
  • movement or performing task
  • pt sees action and then performs it themselves
49
Q

visual learning

A
  • reading info
  • diagrams or graphics
50
Q

what should you always ask the pt after educating them

A
  • ask for feedback
  • evaluates effectiveness of teaching
51
Q

how to evaluate pt understanding

A
  • restating
  • repeating
  • rephrasing
52
Q

barriers to learning can be

A
  • physical
  • developmental
53
Q

how to teach children

A
  • speak at appropriate grade level
  • do not stand over child
  • have child repeat info or demonstrate skill
  • educate parent
54
Q

how to teach pt with visual impairments

A
  • large-print or Braille resource
  • demonstration by handling materials
55
Q

how to teach pt with hearing loss

A
  • speak face-to-face
  • have pt repeat info
  • provide written material
56
Q

how to teach pt with language barriers

A
  • material available in patient’s primary language
  • speak to pt not translator
  • look for nonverbal clues
57
Q

continuity of care

A

continuation of care smoothly from one provider to another so pt receives most benefit and no interruption to care

58
Q

best way to promote compliance

A

communication

Certified Medical Assistant (40 decks)

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