Standards and Ethics Flashcards
OT Process, Management, Evaluation and Intervention
the individuals ability to place the needs of others before their own
altruism
the desire to promote fairness in interactions with others
equality
core concept that states that the desires of the client must OT intervention
freedom
relating in a fair and impartial manner to individuals with whom they interact and respect and adhere to the applicable laws and standards regarding their area of practice
justice
treating each client respectfully and as an individual by enabling the client “to engage in occupations that are meaningful, regardless of level of disability”
dignity
In all situations, OT, OTAs, and OT students must provide accurate information both in oral and written form
truth
use of clinical and ethical reasoning skills, sound judgement, and reflection to make decisions within OTs area of practice
prudence
ethical principle that states that OT personnel shall demonstrate a concern for the well being and safety of the recipients of their services
beneficence
maintaining current knowledge by attending evidence-based educational sessions and using current and updated assessment tools are examples of what ethical principle
beneficence
ethical principle that states that OT personnel shall intentionally refrain from actions that cause harm
nonmaleficence
transferring a client from WC to bed using due care and not practicing OT under the influence are examples of what ethical principle
nonmaleficence
ethical principle that states that OT personnel shall respect the right of the individual to self-determination
autonomy/confidentiality
respecting the clients refusal to participate in OT and complying with HIPPA are examples of what ethical principle
autonomy/confidentiality
ethical principle that states that OT personnel shall provide services in a fair and equitable manner
social justice
promoting the health of members in a facility and treating clients fairly regardless of sex, age, or ethnicity are examples of what ethical principle
social justice
ethical principle that states that OT personnel shall comply with institutional, local, state, federal, and international law and AOTA documents applicable to the profession
procedural justice
learning about laws and regulations and following reimbursement guidelines are examples of what ethical principle
procedural justice
ethical principle that states that OT personnel shall provide comprehensive, accurate, and objective information when representing the profession
veracity
ensuring accurate and truthful documentation and avoiding plagiarism are examples of what ethical principle
veracity
ethical principle that states that OT personnel shall treat colleagues and other professionals with respect, fairness, discretion, and integrity
fidelity
who has jurisdiction over the code of ethics for people who were or are AOTA members when the incident occured
ethics commission
sanction imposed by the ethics commission through a private letter
reprimand
sanction imposed by the ethics commission via a public, formal, notice of disapproval of the behavior
censure
sanction imposed by the ethics commission where as failure to meet certain terms will subject an AOTA member to suspension or permanent revocation
probation of membership subject to terms
sanction imposed by the ethics commission where as membership is withheld for a predetermined time period
suspension
sanction imposed by the ethics commission where as membership is taken away
permanent revocation
ethical problem that occurs when it is difficult to follow through on a course of action that the person knows is right because he or she is tempted to go against it (continuing services for money when they are not medically necessary)
ethical temptation
ethical problem that occurs when it is difficult to follow through on what the person knows is the right course of action because of policies or procedures occurring at the organizational or facility level (providing night services even though the facility is not open)
ethical distress
ethical problem that occurs when it is difficult to identify what the best ethical course of action would be because of conflicts that occur when determining the resolution or two ways to solve a problem (family not wanting the client to know of terminal condition when client is asking whether it is)
ethical dilemma
what does the CARE acronym of documentation stand for
clarity
accuracy
relevance
expectations
what does the COAST method stand for in goal writing
client occupation assistance level specific conditions timeline
what does the SOAP method stand for in note writing
subjective
objective
assessment
plan
what does DAP stand for in note writing
description (subjective/objective)
assessment
plan
what does BIRP stand for in note writing
behavior
intervention
response
plan
what does PIRP stand for in note writing
purpose
intervention
response
plan
what does SIRP stand for in note writing
situation
intervention
response
plan
a multidisciplinary evaluation that is used to determine the specific level of care needed
minimum data set (MDS)
interdisciplinary evaluation used in inpatient rehabilitation settings; OT contribute by scoring the FIM
Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI)
assessment that helps provide guidance for the services the client requires and helps determine the clients eligibility to receive home health; may be complete by OT
Outcome Assessment Information Set (OASIS)
whom does Medicare cover
adult 65 and older, people with disabilities younger than 65, and people with end-stage renal disease
considered the ‘hospital insurance’ aspect of Medicare, covers partial inpatient stays, short stays in a SNF, hospice, and some home health services
Medicare Part A
system of paying for medicare hospital services based on the range of services expected to be provided to each patient on the basis of established diagnosis related groups (DRGs)
prospective payment system (PPS)
_______ days of a SNF stay are covered by Medicare and are paid as part of the ___________
100
per diem PPS
establishes a patients need for services and the prospective per diem rate
resident assessment instrument (RAI) (includes the minimum data set)
what qualifies for hospice services under Medicare
terminal illness with prognosis fewer than 6 months
considered the supplementary medical insurance part of Medicare. covers some outpatient care (physicians visits/OT), some home health services, and some supplies and equipment; premium is paid monthly
Medicare Part B
Medicare part B covers ______ of the cost for outpatient therapy and the client pays any deductible not met and 20% of cost
80%
payment for outpatient service is based on the _________ and takes into account ________ used during service provision
Medicare Physician Fee Schedule
CPT codes
Medicare generally covers about _______ of the approved cost for DME
80%
adaptive equipment such as reachers, dressing sticks, bathtub seats, and grab bars are covered/not covered by Medicare
not covered
Medicare advantage plan offered by a private company that contracts with Medicare
Medicare Part C
added prescription drug coverage to some Medicare plans
Medicare Part D
insurance program that involves a partnership with the state and federal government; general eligibility requirement is income under a certain level and disabilities; covers early and periodic screening, diagnosis, and treatment for people younger than 21
Medicaid
health coverage for children and families with incomes too high to qualify for Medicaid, but who can’t afford private coverage
Children’s Health Insurance Program (CHIP)
IDEA services that covers children and young adults with disabilities ages 3-21
IDEA Part B
IDEA services that covers infants and toddlers ages 0-2
IDEA Part C
allows related services (such as OT) to be billed to Medicaid though the school system under certain conditions
Medicare Catastrophic Coverage Act
program to identify improper payments made on claims of health care services provided to Medicare beneficiaries
Medicare Recovery Audit Program
making a false statement or representation of material facts to obtain some benefit or payment for which no entitlement would otherwise exist (billing for services not provided)
fraud
describes practices that either directly or indirectly result in unnecessary costs to the Medicare program (billing for services that were not medically necessary)
abuse
service delivery system where clients can be readmitted for necessary procedures, and the hospital is able to keep clients in its market by placing them in affiliated systems
hospital with vertical organizations
service delivery system where larger hospital systems take over smaller hospitals or facilities to create a large health care delivery system
health network
most common form of managed care where control is maintained over services by requiring enrollees to see doctors within the network and obtain referrals prior to seeking specialty/ancillary care; primary care physicians assume some financial risk for the care provided to its enrolled members
health maintenance organization (HMO)
integrated delivery system where the people who belong to it are able to go directly to a specialist without going through the primary care physician; greater choice; as choice increases, percentage of payment decreases
preferred provider organization (PPO)
health care plan that is similar to HMO’s but sometimes allows people to refer themselves to physicians who do not belong to the network
point-of-service plan
an analysis of systems or organizations that change based upon chaos, complexity, and dynamic systems
dynamic systems theory
style of leadership characterized by motivating others to reach their highest potential and providing inspiration to others to work effectively together to meet goals of the organization or groups
Transformational Leadership
leadership style in which leaders clarify role and task requirements and provide followers with positive and negative rewards contingent on successful performance
Transactional Leadership
the study of non verbal communication
paralinguistic
relates to body language
kinesics
the study of space, including the use of personal space during communication
proxemics
standards for continuing competence (5)
- knowledge
- critical reasoning
- interpersonal skills
- performance skills
- ethical practice
practitioners must acrue _______ hours of professional development units every _____ years to maintain NBCOT certification
36 hours
3 years
accrediting body whose purpose is to continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value
Joint Commission
independent, non profit organization focused on advancing the quality of services you use to meet your needs for the best possible outcomes
CARF Internation
the process of ensuring that an organizations current purpose, aspirations, goals, activities, and strategies connect to plans and support its mision
strategic planning
an organizations core, underlying purpose, or basis for its existence, focus, and actions
mission
the ideal state or ultimate level of achievement to which an organization aspires
vision
a process that identifies and analyzes the organizations strengths and weaknesses and describes the opportunities and threats that may have an impact on its ability to grow and prosper
SWOT analysis
the monetary flow of the organization (money that comes into the organization and that is used by the organization for expenses)
cash flow
a specific way to allocate where the organizations money is spend, how much money is allotted for various expenses, and the money that comes into the organization
budget
the costs assosciatd with opening a business
startup costs
the ongoing costs of operating the business (utilities, rent, equipment)
operational costs
analyzing the market to see whether the product or services you would like to sell are desirable
market analysis
management process that evaluates the arrangement of people, equipment, and procedures in a series of tasks intended to repeatedly produce a desired end result
continuous quality improvement
indicates how well an assessment produces consistent scores over time and across raters
reliability
indicates the degree to which an assessment measures what it states it measures
validity
what does the continuous quality improvement approach: FOCUS-PDCA stand for
find the process that needs improvement organize people who understand clarify the issues understand inconsistency select a solution plan for improvement do the improvement check if improvement was effective act to ensure maintenance
what are the 4 standards of practice
I: professional standing and responsibility
II: screening, evaluation, re-evaluation
III: intervention
IV: outcomes
method of supervision that is face to face and includes observation, modeling, co-treatment, discussion, teaching, and instruction
direct supervision
method of supervision that occurs by phone or written or type communication and receiving feedback from others
indirect supervision
what precautions should be followed for all evaluations
standard and transmission based
how well an assessment appears to address the stated purpose
face validity
extent to which the items on a test are fairly representative of the entire domain the test seeks to measure.
content validity
measures how well a new test compares to an well-established test; or 2 instruments administered at the same time
concurrent validity
the degree to which an instrument can predict performance on future criterion
predictive validity
the extent to which different raters will achieve the same results on a test
interrater reliability
the extent to which the same results will be obtained on an assessment that is administered by the same person twice
test-retest reliability
degree to which items agree/relate
correlation
reducing the incidence/occurrence of disability in populations at risk
primary prevention
early detection of problems in populations at risk to reduce or minimize duration of disability
secondary prevention
eliminate or reduce the impact of dysfunction on an individual
tertiary prevention
the process of identifying problems, setting goals, and developing a treatment plan
procedural reasoning
presents an occupational story and process of change needed to reach an imagined future
narrative
reasoning with a focus on treatment possibilities in a given setting
pragmatic reasoning
includes ongoing revision of treatment, integration of various types of reasoning in context; represents multi-dimensional thinking
conditional reasoning
type of group leadership where the therapist is responsible for planning and structuring groups
directive leadership
type of group leadership where the therapist shares responsibility for group and process with members
facilitative leadership
type of group leadership where the therapist serves as a resource to members who set the agenda and structure of the group
advisory leadership
activity group that enables assessment of skills, assets, and limitations in group interactions; activity is introduced but not intervened; includes a task that is completed in one session that requires interaction
evaluation group
activity group that assists members in acquiring knowledge, skills, and attitudes to perform activity; behaviors practiced with reinforcement; parallel group interaction skills required
thematic group
activity group that discuses activities engaged in outside of the group to enable effective management’; discussion of concerns, solutions, and strategies; includes role play and home work
topical group
activity group that increases clients awareness of needs, values, ideas, feelings, and behaviors; therapist is active initially then slowly fade; activities have end-product or demonstrable service
task-oriented group
continuum of groups focused on developing group interaction skills
developmental group
type of developmental group where individuals perform individual tasks in the presence of others
parallel groups
type of developmental groups where individuals perform a shared, short-term activity with another member; focus is on interaction not completion
project/associative group
type of developmental group where individuals select and implement a long-range activity that requires group interaction skills to complete; members may fulfill functional leadership roles; activity completed over multiple sessions
egocentric-cooperative/basic cooperative
type of developmental group where individuals engage in group activity which facilitates free expression of ideas and feels; leader is a non-authoritarian advisor; activity is secondary to need fulfillment and may not have end product
cooperative/supportive cooperative group
type of developmental group where individuals assume all functional socio-emotional and task roles within a group; therapist acts as peer; requires end product or time limit
mature group
type of group that helps members function at highest possible level for as long as possible; goal is to prevent regression, maintain function, and meet health needs
instrumental group
precautions used for tuberculosis, measles, and chickenpox
airborne precautions
precautions used for mumps, rubella, pertussis, and the flue
droplet precautions
precautions used for patients with known or suspected infection of serious illness transmitted by direct patient contact or contact with items in the patients environment
contact precautions
level of supervision that includes daily direct contact at the work site
close supervision
level of supervision that includes direct contact every 2 weeks with interim supervision using other methods (email)
routine supervision
level of supervision that includes monthly direct contact and the supervisor is available as needed by other methods
general supervision
level of supervision that includes supervision a needed basis but may be less than monthly
minimal supervision
type of team where members support and enhance the activities and programs of other disciplines to provide quality services; role-blurring accepted
transdisciplinary team
develops rules and regulations pertaining to federal laws governing the Medicare and Medicaid programs
center of Medicare and Medicaid services (CMS)
person receiving services
beneficiary
payment system where provider is paid prospectively a set fee for each member of a specific population regardless of health care delivered
capitation
typical capitation payment system
per member per month (PMPM)
monetary amount to be paid by the patient, expressed as percent of total charge
co-insurance
standardized recommended intervention protocol for specific diagnosis
clinical/critical pathway
descriptive category established by CMS that determines the level of payment at a per case rate
diagnostic related groups (DRG)
payment system where provided is paid same type of rate per unit of service (payers pay 80% and patient responsible for remaining 20%)
fee for service
established by the affordable care act to allow consumers to compare the cost of insurance plans in their area
health insurance marketplace
method of maintaining control over costs ant utilization of services while providing quality health care; includes MCOs, HMOs, and PPOs
managed care
negotiated, per day fee for service (inpatient and SNF)
per diem
nationwide payment schedule that determines the Medicare payment for each inpatient stay of a Medicare beneficiary based on DRGs
prospective payment system (PPS)
Medicaid form a primary care physician must complete to document need for requested medically necessary covered services with a supporting rationale
treatment authorization request (TAR)
average cost of specific health care procedures in a geographic area; maximum amount insurer will pay for a service or covered expense
usual and customary rate (UCR)
those who are contracted through Medicare to handle the day to day operations
intermediaries
payment system based on client characteristics regardless of amount/type of services provided
patient driven payment model (PDPM)
how is home health re-imbursed
prospective payment system with rate per episode of care
system used to determine episode payment rate for home health
home health resource groups (HHRGs)
what is a home health episode
60 day period beginning with first billable visit and ending 60 days after
payment system for outpatient services that are according to a fee schedule
resource-based relative value scale (RBRVS)
program affiliated with a hospital or community mental health day program for individuals who would otherwise have required inpatient psychiatric care
partial hospitalization program (PHP)
what needs to be done for changing documentation
cross out, initial, and date with a black/blue pen
what does the acronym SMART stand for in goal writing
specific measurable attainable relevant time-limited
what does the acronym RUMBA stand for in goal writing
realistic/relevant understandable measurable behavioral attainable/achievable
structure for a progress note based on a problem list
problem oriented medical record (POMR)
describe the condition or medical reason for requiring services (ICD most common)
diagnosis code
payment system for outpatient services
merit-based incentive pay system (MIPS)_
functional data reported on claims for outpatient services that identify the primary issues being addressed
g-codes
ten separate legislative titles that seek to improve accessibility, fairness, quality, efficiency, accountability, and affordability of health insurance coverage
Patient Protection and Affordable Care Act (ACA)
requires CMS to develop acute care practice guidelines for non pharmacological pain management and opioid use prevention
substance use-disorder prevention that promotes optimal recovery and treatment (SUPPORT)
monthly incomes for persons with disabilities to enable community living
supplemental security income (SSI)
prohibits discrimination based on disability in federally funded programs
rehabilitation act of 1993
prevention of employment discrimination
ADA Title I
methods to make materials visually available, provide qualified interpreters, and make equipment and actions that increase accessibility
ancillary services
who is exempt from ADA
US government, Indian Tribes, and private/tax-exempt membership clubs
prevention of discrimination in public entities
ADA Title II
prevention of discrimination by public services (public or privately owned)
ADA Title III
prevention of discrimination in telecommunications
ADA Title IV
strives to make it more realistic and easier for persons with disabilities to work by removing disincentive to work, enabling choice in service providers, and establishing vocational programs
Ticket to Work and Work Incentives Improvement Act (TWIIA)
national employment and vocational training system that serves as a ‘one-stop’ delivery system for adults seeking access to employment and training to allow universal access to persons with disabilities
work investment act
general education law that emphasized standards-based education with focus on improve educational opportunities and outcomes for children from lower income families
every student succeeds act (ESSA)
formally no child left behind act
enables American’s receiving retirement social security (SS) benefits to be able to work without it affecting their SS income
freedom to work act
mandate comprehensive resident assessment system administered at admission and on an annual basis unless significant change in condition; coordinated by RN
minimal data set
guidelines to follow when conditions identified on MDS
resident assessment protocol (RAP)
legislation that emphasized restraint reduction and restraint-free environments whenever possible
omnibus budget reconciliation act (OBRA)
how long must an individuals LOS be in a tong-term acute care hospital to maintain Medicare certification
> 25 days
eligibility criteria for early intervention services based on the extent of developmental delay requires
33% in one area or 25% in two areas
for IFSP, review are done:
every 6 months
developmental ares of early intervention evaluation
cognition, physical, communication, social-emotional, adaptive
program for adolescents or adults who require intervention to develop skills needed for secondary/post secondary education
supported education program
program for adolescents and adults who require intervention to develop skills to work
prevocational programs
program for development of specific vocational skills with prerequisite abilities to work but still requires training for specific job, ongoing structure, support, and supervision
vocational program
vocational program where discharge is not necessarily the goal
rehab/sheltered workshop or supported employment
vocational program that is time limited (3-6 months) with discharge to competitive employment, supportive employment, or a rehab workshop
transitional employment program (TEP)
vocational program with ongoing support, intervention, and referrals to employees
employee assistance program (EAP)
program open to adults and elders with current mental illness or history of a mental illness; services and operations provided by staff; open 5-7 days a week with daily schedule organized around work ordered day; individuals can enter and exit at will; role of OT integrated not formal
clubhouse program
program for adults and elders with chronic physical/psychosocial impairment of frail/semi-independent older adults; services provided in congregate group setting; 1-5 days a week
adult day care
system of management based on a core set of goals for the program
management by objective (MBO)
permanent/long-term purchases typically above a fixed amount ($500); separated due to depreciation of value and possible tax credits for purchases and investments
capital expenses
costs related to service provision (salaries, benefits, supplies, equipment)
direct operating expense
costs shared by the setting as a whole (utilities, housekeeping, marketing)
indirect operating expense
costs that remain at the same level even with change in amount of services (rent)
fixed operating cost
costs that change in direct proportion to the amount of services (splint materials)
variable operating cose
the amount of time a full time employee works
full time equivalent
a cost-volume profit analysis where volume of services needed for revenue to equal cost and profits to equal 0
break-even analysis
system oriented approach that view limitations and problems proactively as opportunity to increase quality; emphases prevention and problems as organizational
quality improvement
quality improvement method where current services are reviewed for enhancement of future services
prospective viewpoint
creates an organizational culture that enables employees to contribute to environment of continuous improvement to meet/exceed consumer needs
total quality management
evaluates the appropriateness of quality of services through an interdisciplinary system focus that is client centered and emphasizes ethics, performance, and leadership
performance assessment and improvement (PAI)
evaluation tool that attains client goals for intervention and measures goal attainment and intervention outcomes after a specified time period
goal attainment scaling (GAS)
plan to review the use of resources in a facility to determine medical necessity and cost efficiency; is an aspect of QI and PAI
utilization review (UR)
review of reimbursement claims analyzed to determine efficient/cost-effective care; can be done via peer reivew
statistical utilization review
groups of peers who evaluate appropriateness of services and quality of care under reimbursement/state licensure requirements
professional review organization (PRO)
identifies, evaluates, and takes corrective action against risk and plans, organizes, and controls activities/resources to decrease actual or potential losses
risk management
5 P’s of marketing strategies
product price place promotion position
2-group research design with random selection/assignment into experimental or control groups; treatment = independent variable; outcome = dependent variable; cause and effect relationship examined
true-experimental
independent variable manipulated to determine the effect on the dependent variable with less degree of research control and/or no randomization
quasi-experimental
research method where there is no manipulation of independent variable because randomization/control is not possible; correlational coefficient expressed; may be prospective, retrospective, descriptive, or predictive
non-experimental/correlational
research method to determine how one or more person makes sense of an experience
phenomenological
research method to determine patterns/characteristics including values, roles, beliefs via field observation, interview, or cultural emersion
ethnographic
complete involvement of the researcher in experience to understand and interpret phenomena
heuristic
single subject or group of subjects investigate in an in depth manner
case study
level of confidence that findings reflect truth and reality attained with no pre-conceived notions and is enhanced by extended/various field experience and good interview techniques
credibility
how well findings can fit into similar contexts “goodness of fit”
transferability
inclusion of the full range of data including outliers and atypical findings
dependability
degree to which conclusions are based on data
confirmability
method of sampling where participants are selected from a population list and selected at specified intervals
systematic
method of sampling where participants are selected from population identified subgroups based on predetermined characteristics
stratified
method of sampling where participants are selected purposefully and deliberately
purposive
method of sampling where participants are selected who meet population criteria based on availability
convenience sampling
method of sampling where participants are selected by previous participates providing names of other participants who meet the study criteria
network/snowball
survey instrument with a point scale with opposing objectives or 2 extremes
semantic differential
survey instrument which indicates level of agreement on a 5-point scale (typical)
Likert scale
survey instrument which indicates order of importance (uses no more than 10)
Guttman scale rank ordering
survey instrument where a response is selected that reflect an individuals opinions and attitudes
multiple choice
survey instrument where a phrase is provided and the respondent completes the sentence
incomplete sentence
measures that determine average or typical scores
measures of central tendency
determines the variability of scores from the mean
standard deviation (SD)
symmetrical bell-shaped curve indicating distribution of scores; half the scores are above and below the mean; most scores near the mean with 68% +1 or -1 SD from the mean
normal distribution
describes the score position within a distribution relative to other scores
percentile/quartiles
estimate of expected error in individual score; measures response stability and reliability
standard error of measurement
estimates the true difference not due to chance
test of significance
preselected level of statistical significance
alpha level
based on the number of subjects and groups; determines the level of significance based on consulting appropriate table for each statistical test
degree of freedom
expected chance variation among means as the result of sampling error
standard error
null hypotheses rejected by research when it is true (mean scores concluded to be truly different when difference is due to chance)
type I error
null hypotheses is not rejected when it is false (mean scores are concluded to be due to chance when means are truly different)
type II error
testing based on population parameters for interval or ratio data
parametric statistics
parametric statistic; comparison of group means and identified difference at selected probability level
t-test
parametric statistic; comparison of groups while also controlling for the effects of intervening variables (co-variables)
analysis of variance (ANOVA)
testing not based on population parameters ordinal or nominal data; less powerful
non-parametric statistic
comparison of data in form frequency counts occurring in 2 or more exclusive categories
chi-square test
determines the relationship between 2 variables
correlation statistic
correlated ordinal data
Spearmans rank correlation coefficient
reliability based on analysis of variance
intraclass correlation coefficient (ICC)
correlation coefficient 0.7-1.0
high
correlation coefficient 0.35-0.69
moderate
correlation coefficient 0-0.34
low
correlation coefficient 0
no relationship
negative correlation -1-0
inverse relationship
what ethical principle includes not having a relationship with a patient
nonmaleficence
