Patient care coordination and education module

Question 1

care coordination

Answer 1

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

Question 2

Affordable Care Act

Answer 2

• also known as Patient Protection and Affordable Care Act (PPACA)
• legislation signed into law in 2010 that increased the quality, availability, and affordability of private and public health insurance
• three main goals: expand health insurance coverage, shift the focus of health care delivery system from treatment to prevention, and reduce costs and improve the efficiency of health care

Question 3

patient-centered medical home (PCMH)

Answer 3

• a model philosophy intended to improve the effectiveness of primary care

Question 4

accountable care organization (ACO)

Answer 4

• an association of providers and third-party payers that assumes a defined range of responsibilities for a specific population and is held accountable, financially as well as through specific quality indicators, for its members’ health

Question 5

holistic health care

Answer 5

• comprehensive or total patient care that considers the physical, emotional, social, economic, and spiritual needs of the person

Question 6

primary care providers

Answer 6

• the first provider the patient seeks care from
• main goal: to coordinate preventative health care services
• can be family practitioners, internal medicine or doctors of osteopathy, or pediatricians

Question 7

specialists

Answer 7

• provider that diagnoses and treats conditions that require a specific area of expertise and knowledge
• PCP’s may refer patients to a specialist to diagnose or treat a specific short-term condition
• patients with chronic diseases may work with specialists for an ongoing period of time

Question 8

physician assistants

Answer 8

• have similar training to physicians and are licensed to practice medicine as long as they are supervised by a medical doctor
• can conduct physical exams, provide preventative car, prescribe diagnostic tests, assist with surgical procedures, diagnose illnesses, and prescribe medicine

Question 9

advanced practice nurses

Answer 9

• have more education and experience than RN’s
• can usually perform the same tasks as a physician assistant
• clinical nurse specialist, nurse anesthetists, nurse practitioners, and nurse midwives are common advanced practice nurses

Question 10

registered nurses

Answer 10

• licensed by individual states and have an associate or bachelor’s degree in nursing
• RN’s usually oversee the case management of patients who have complex chronic conditions
• coach patients about their overall health

Question 11

practical nurses

Answer 11

• sometimes referred to as vocational nurses
• are licensed by individual states
• usually train for approx. 1 year at a community college or vocational school, receiving a diploma or associate degree
• often triage phone calls, administer medications, and assist with other clinical duties

Question 12

pharmacists

Answer 12

• prepare and dispense medications prescribed by authorized providers
• must be knowledgeable of individual and various combinations of medicines to be able to educate patients on their use and answer questions about side effects
• using a pharmacist to implement medication therapy management is relatively new to ambulatory care

Question 13

dentists

Answer 13

• diagnose and treat issues relating to the teeth and mouth
• dentists also educate patients on ways to prevent problems with oral health
• many community health centers include oral health services to patients

Question 14

occupational therapists

Answer 14

• assist and educate patients on how to perform everyday tasks after a physical, mental, or developmental disability has occured

Question 15

physical therapists

Answer 15

• assess a patient’s pain, strength, and mobility and then develop a treatment plan to improve any areas of concern

Question 16

speech therapists

Answer 16

• work with patients who have problems with speech and swallowing due to an injury, cancer, or stroke
• focus on helping a person work toward improving, regaining, and maintaining the ability to communicate, chew, and swallow

Question 17

psychiatrists

Answer 17

• MDs who diagnose, prescribe medications, and treat mental, behavioral, and emotional disorders

Question 18

psychologists

Answer 18

• not MDs but have a doctor of psychology or a doctor of philosophy degree
• work with patients who are experiencing mental health challenges, especially during times of stress or turmoil

Question 19

social workers

Answer 19

• assist patients and families in times of transition or crisis
• assist patients in clinical or hospital settings with physical, emotional, and financial issues related to an illness or injury
• social workers often coordinate additional services (transportation, housing, access to meals, financial resources, long term, hospice services)

Question 20

registered dietician nutritionist

Answer 20

• an expert in diet and nutrition
• educate patients on the connection between chronic disease and poor nutrition, assist with menu planning, and help low-income patients obtain healthier foods at a lower price

Question 21

five core functions and attribute of the PCMH

Answer 21

• comprehensive care: an approach that cares for all of the patient’s needs (the whole patient, not just medical and physical concerns), involves providers as well as the entire health care team
• patient-centered: positions patients and their families as core members of the team; the focus is on individual needs and preferences of the patient throughout various stages of life
• coordinated care: all specialty care, hospitals, home health care, and community services are overseen by the provider-directed medical practice; the PCMH works at creating and maintaining open communication between the patient and other members of the team (aided by information technology, EMR, EHR)\
• accessible services: providing tools (open-scheduling, extended hours, communication with providers) through patient information web portals
• quality and safety: commitments include delivering quality health care; met by delivering evidence-based medicine that is assessed by collecting safety data and measuring and responding to patient experiences and satisfaction

Question 22

compliance

Answer 22

• meeting the standards and regulations of the medical practice’s established policies and procedures

Question 23

auditory learning

Answer 23

• achieved by hearing the information
• can be accomplished with providing information verbally while the patient listens

Question 24

kinesthetic learning

Answer 24

• involves movement or performing the task
• someone who learns this way needs to see the action and then perform it themselves
• a demonstration of the skill needed with a return demonstration or an anatomical model the patient can touch works best

Question 25

visual learning

Answer 25

• involves reading the information and seeing diagrams or graphics
• the patient can have overlaps in these learning styles, so it is important to ask what they consider to be their best methods of learning

Question 26

continuity of care

Answer 26

• continuation of care smoothy from one provider to another, so that the patient receives the most benefit and no interruption to care