Specialty Care, Inpatient, Collaboration, Etc. Flashcards

1
Q

Value Based Purchasing

A

uses hospital quality metrics in five domains for reimbursement. Result in ‘pay for performance’

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2
Q

New Look of Primary Care

A

Patients want 24/7 access and low waits, this resulted in retail health movement / urgent care that offer many primary care services as well as the concierge practice movement.

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3
Q

Distinguish between different types of primary and specialty care practices

A

PCPs have broad knowledge, specialists focus on the management of specific conditions and/or body systems.

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4
Q

5 Elements of the primary medical home

A

Comprehensive care
Patient centered
Coordinated Care
Accessible Services
Quality and Safety

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5
Q

Define the patient-centered medical home model

A

provides health care that is relationship based with orientation towards the whole person, understanding and respect for unique needs / culture / values / preferences and supports patients in managing their own care with family as part of the care team.

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6
Q

Guidelines for improving quality of care and communication during transitions

A

Medication reconciliation, send clinical summary to PCP or to referral specialist, provide patient education and written discharge instructions

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7
Q

Define accessible services

A

In the context of the PCMH, it means shorter waiting times for urgent needs, enhanced in-person hours, around the clock access to member of the care team, and alternative communication methods such as email or texting.

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8
Q

Primary Care

A

General healthcare focusing on preventative and care for common medical issues as well as continuing care and coordination of specialty care.

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9
Q

Urgent Care

A

unscheduled provider care facility that provides a variety of primary and emergency care.

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10
Q

Outpatient specialty

A

Primary care is outpatient care, and outpatient specialists are providers in a specific speciality that provide care to patients outside the hospital

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11
Q

Inpatient Care

A

A patient who has been admitted to the hospital

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12
Q

Extend care facilities

A

Umbrella term for both skilled and non-skilled facilities.

Assisted living, retirement communities, memory-care units, and long-term care are all used for individuals with stable, chronic conditions with varying capacities to care for themselves. On the other hand, patients in skilled nursing facilities need skilled services, such as physical therapy or complex wound care. This is often the case after surgeries and other hospitalizations. Typically, patients do not reside in skilled nursing facilities. When patients have stabilized (or their insurance stops paying for therapy), they are transitioned to long-term, nonskilled care.

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13
Q

Best practices in urgent care for transitions of care

A

Ask patients who their PCP is, who their home care provider is, send a clinical summary of the visit to their PCP and home care provider, send summary to the ED is referred to the ED, always perform a medication reconciliation, provide patient with effective education and written discharge instructions

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14
Q

Best practices for urgent care in general

A

Operational excellence
patient experience
engaged, empowered employee culture

‘no wait, no waste, no hassle’. Be consumer focused and technologically saavy

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15
Q

Increasing need for NP in specialty care

A

Physician specialty shortage by 2025 and APRNs are growing faster than physicians

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16
Q

Scope of practice for NPs as defined by NCSBN

A

APRNs come in four roles and in at least 6 population foci.

CRNA - Anesthetist
CNM - Midwife
CNS - clinical specilaist
CNP - nurse practitioner

CNPs are educated and practice at an advanced level to provide care in a range of settings and in one of six patient populations - family, pediatric, internal medicine, geriatrics, women’s health

17
Q

Difference between FNP and ACNP

A

Family nurse practitioners (FNPs) provide primary care to individuals across the lifespan while acute care nurse practitioners (ACNPs) provide care in hospital and other institutional settings for acute illness / disease management

18
Q

Expansion of roles of the NP

A

Movement towards a APRN compact license. The consensus model to standardize licensure by 4 domains and/or population context, and specific specialties identified by professional organizations not the state.

19
Q

NP role in post-acute and long-term acute care

A

Expand care and reach, can do non-skilled admissions, reduce readmission, setting and meeting of care goals, fill the gaps of fewer specialist physicians in PA/LTC care of older adults

20
Q

Discuss the role of the NP in co-management of care

A

as the primary care provider, it’s your job to make sure that all the patient’s needs are managed one way or another, which is the foundation for the patient medical home model. Within your practice, a team-based care approach will also ensure effective communication between all clinicians, staff, patients, and families.

The PCP should be the central hub to coordinate care and information and request / compile information from specialists

21
Q

Explain how to co-manage patients requiring expertise of specialty practice

A

Explain the reason / need for the specialists and the urgency (if applicable). Select an appropriate specialist, communicate to the specialist the reason for the consult with a consult letter / introduction, use a tracking system for follow-up, use a co-management agreement with the specialist that details how the care will be managed

22
Q

Review key elements of SOAP note

A

Subjective (patient tells you)
Objective (findings of exam, tests)
Assessment (possible diagnosis, differentials)
Plan (specific actions and goals)

SOAP note should tell a story and flow into the assessment. Be careful with diagnosis as they are labels. The plan should be specific not general.

23
Q

Process of pre-surgical clearance

A

Process to identify previously undiagnosed disease or risk that could impact surgical care.

24
Q

Low risk surgical procedures

A

cataracts removal, carpal tunnel surgery, breast biopsy, inguinal hernia repair

25
Q

Key aspects of pre-surgical eval

A

Medication reconciliation (including OTC)
Review of systems
Physical exam (focus on surgery problem)
Pre-surgical tests depend on type of surgery, anesthesia, patient age / history, and surgeon preference

All reproductive age women need a pregnancy test

Any possible heart issues need cardiology clearance

Any febrile illness cannot be cleared

26
Q

How to co-manage patients from pre-op physical to hospitalization follow up and rehab

A

PCP follow up is needed for non-surgical specific complications (constipation, etc). Monitor home rehab. Medication reconciliation is vital!

27
Q

Key componenets of the checklist to reduce readmissions

A

Review the discharge summary and clarify with sending physician, ask patient to explain their goals, factors the led to admission, medication reconciliation esp to differences, determine need to make medication changes, follow up tests, future treatment plans, provide self-management education and warning signs, provide reconciled medication list to patient / caregiver, communicate care plan and changes, make follow up appointment

28
Q

Challenges in accessing rehab services in primary care

A

Lack of leadership / championing benefits of rehab services
Misconception that rehab is a ‘luxury’ or a ‘fall back’ solution for primary care failure or for disability-specific
Lack of rehab professionals to meet need
Poor referral system for rehab services
Limited access to assistive products
Limited data (esp in developing nations)

29
Q

Importance of quality improvement

A

essential to achieving the triple aim of improving the health of the population, enhancing patient experiences and outcomes, and reducing the per capita cost of care

One prominent approach to redesigning primary care, the patient-centered medical home (PCMH), requires primary care practices to have a systematic focus on QI and safety.

30
Q

Strategy to coordinate interoffice collaboration

A

Attend interdisciplinary meetings, staff meetings, clear communication, engage with all members of the care team, engage in collaborative education activities, have knowledge of teams and teamwork

31
Q

Transition from research to best practice

A

Translational research is the movement of research from the bench to practice with the understanding of how the research supports the practice change to improve outcomes.

Use of a framework, theory, or model to systematize and guide the planning, implementation, and evaluation of practice change projects supports successful implementation of EBP. There are many models for implementation of EBP available for use in clinical settings; however, selection is dependent on the setting and type of practice change proposed.

32
Q

What is the APRN consensus model for?

A

A nationwide standard of licensing APRNs that involves 4 areas (CRNA, CNM, CNS, and CNP) and 6 population foci (family, pediatric, women’s, psych, internal medicine / acute, and geriatric)

33
Q

Quality measures for the NP

A

Ongoing Professional Performance Evaluation (OPPE) and the Focused Professional Practice Evaluation (FPPE) may be used for NPs. Six domains - patient care, medical knowledge, practice based learning / improvement, interpersonal / communication, professionalism, and system-based practice

Quality measures for NPs can be used for reimbursement, compensation, etc.

34
Q

Challenges in primary care and how NPs can influence future practice

A

Compact license movement, increased use of technology to communicate, improve collaboration, be patient and population centered, focus on health promotion and wellness

35
Q

External supports for QI

A

Data feedback / benchmarking
Practice facilitation / coaching
Expert consultation / mentoring
Shared learning collaboratives

36
Q

Examine the implementation of a system-wide improvement project in primary care

A

There is no nationwide system but areas, private parties, grants, and organizations can provide support for QI projects.

In the past, some states have used primary care redesign to improve primary care quality