Practice Issues, Trends, and Health Policy

Question 1

What is an advanced directive?

Answer 1

a written statement of a patient’s intent/desires regarding medical treatment.

Question 2

What is a healthcare directive?

Answer 2

a type of advanced directive that may or may not include a living will and/or durable power of attorney designation.

Question 3

What is a living will?

Answer 3

a document which specifies which life-prolonging measures one does or does not want to be taken if he/she becomes incapacitated.
Often times this document includes designation of a DPOA.

Question 4

What does Title I of HIPAA encompass?

Answer 4

It provides health insurance coverage through COBRA for workers and their families when they change or lose their jobs.

Question 5

What is Title II of HIPAA?

Answer 5

requires the establishment of `national standards for electronic health care transactions and national identifiers for providers, health insurance plans, and employers

Question 6

What are some examples of those not required to follow HIPAA?

Answer 6

life insurers, employers, workers comp carriers, many schools and school districts, many state agencies such as child protective services, law enforcement, municipal offices

Question 7

What is the Patient Safety and Quality Improvement Act

Answer 7

A voluntary reporting system for which to report medical errors. This act aims to improve reporting and analysis of patient safety events in order to increase data and gain a better understanding of patient safety events.

Question 8

True or False.

The “duty to warn” supersedes a patient’s right to confidentiality.

Answer 8

TRUE

Question 9

True or False.

A patient’s right to confidentiality outweighs the duty to protect a patient from harming him/herself.

Answer 9

FALSE.

The duty to protect that patient from harming him/herself supersedes the right to confidentiality.

Question 10

What is the strongest method to evaluate teaching?

Answer 10

return demonstration.

Question 11

Which 5 conditions must be reported to the Health Department?

Answer 11

HIV, TB, Syphilis, Gonorrhea, Chlamydia

Question 12

What are the goals of Healthy People 2020?

Answer 12

To increase the quality and years of healthy life and to eliminate health disparities.
…with the intent to plan prevention programs that grant equal access, availability, cost and quality of care.

Question 13

True or False.

NPs are not legally required to report domestic violence.

Answer 13

TRUE

Question 14

What is covered in Medicare Part A?

Answer 14

Inpatient services and the extension of inpatient services such as home health, hospice, and SNF for those > or = 65yo

Question 15

What is covered in Medicare Part B?

Answer 15

Outpatient services: clinic visits, labs and diagnostic procedures, medical equipment, outpatient hospital services, and some home health services.

Question 16

What is covered in Medicare Part C?

Answer 16

eligibility to receive all of their health care services through one of the provider organizations under Part C (HMOs, PPOs). This is known as the “MediCare Advantage.”

Question 17

What is covered in Medicare Part D?

Answer 17

Limited drug prescriptions.

Question 18

What services are not covered by Medicare?

Answer 18

regular physical exams, health maintenance screenings, counseling for well patients (to name a few)

Question 19

What are the rules to “incident-to” billing?

Answer 19

1. Services must be an integral part of the physician’s services
2. Services are commonly rendered without charge or included in the physician’s offices or clinics
3. Furnished under the physician’s direct personal supervision
4. The physician must perform the “initial service and subsequent services of a frequency which reflects his or her active participation in the management of the course of treatment.”
5. Not allowed in the hospital setting

Question 20

What are the four roles of the NP?

Answer 20

Clinician, Consultant/Collaborator, Educator, Researcher

Question 21

Define autonomy.

Answer 21

Duty to respect an individual’s thoughts and actions

Question 22

Define veracity.

Answer 22

Duty to be truthful.

Question 23

Define fidelity.

Answer 23

Duty to be faithful.

Question 24

Define justice.

Answer 24

Duty to be fair.

Question 25

Define beneficence.

Answer 25

Duty to prevent harm and promote good.

Question 26

Define utilitarianism.

Answer 26

The right act is the one that produces the greatest good for the greatest number.

Question 27

Define nonmaleficence.

Answer 27

The duty to do no harm.

Question 28

What are the different types of research?

Answer 28

Non-experimental (descriptive and ex post facto/correlational research), cross sectional, cohort, longitudinal, experimental, qualitative.

Question 29

What is the t-test?

Answer 29

statistical test to evaluate the differences in means between two groups.

Question 30

What designates the level of significance?

Answer 30

p value. Indicates statistically significant differences between groups.

Question 31

What is a confidence interval?

Answer 31

the specified probability of including the parameter being estimated.
*a small CI implies a very precise range of values

Question 32

What does -1 represent in ‘perfect correlation’? 0? +1?

Answer 32

-1= a perfect negative correlation.
0= absence of correlation.
\+1= a perfect positive correlation.

Question 33

Define reliability.

Answer 33

Estimated repeatability of a measurement- the degree to which an instrument measures the same way over time with the same subjects.

Question 34

Define validity.

Answer 34

The degree to which a variable measures what it is intended to measure.

Question 35

What is Cronbach’s alpha?

Answer 35

correlation among values among the questions on the instruments- the closer it is to one (> or= .70) the higher the reliability estimate of the instrument.

Question 36

What are the levels of evidence?

Answer 36

Level I: Evidence from a systematic review of all relevant RCTs, or evidence-based clinical practice guidelines based on systematic reviews of RCT’s
Level II: Evidence obtained from at least one well-designed RCT
Level III: Well-designed controlled trials without randomization, quasi-experimental
Level IV: Case-control and cohort studies
Level V: Systematic reviews of descriptive and qualitative studies
Level VI: Single descriptive or qualitative study
Level VII: Opinion of authorities and/or reports of expert committees

Question 37

What is the pyramid of levels of evidence?

Answer 37

Systematic Review.
RCT.
Cohort studies.
Case-Control Studies.
Case Series, Case Reports.
Editorials, Expert opinion.