Unit 1 American Healthcare Delivery System Flashcards
What are the levels of care?
Primary:
- Primary care MD’s, NP’s
- Pediatricians, OB/GYN’s
Secondary:
- Speciality care
- Referrals (cardiologists, oncologists)
- Screenings
Tertiary:
- High specialized care
- Open heart Sx
- Dialysis
- Neurosurgery
What are the types of managed care?
HMO:
- needs referral, uses “gatekeeper”
- more restricted than PPO
- employer negotiates set price with company for employee
PPO:
- No referrals “gatekeeper”
- More expensive
What is Medicare? Who is it for? What are the four parts?
-Largest single payer healthcare
- Insurance 65 yoa and older
- Disabled, renal failure, ALS, etc. (need to be permanently disabled)
Part A = Hospital
Part B = Outpatient
Part C = Medicare Advantage (supplemental)
Part D = Medications
What is Medicaid?
Healthcare for those with limited recourses
Describe what is long term care and how it works.
- The individual pays until funds are $2,000 than Medicaid kicks in.
- HMOs, PPO’s, and Medicare do NOT pay.
- Short subacute stays 100 days/incident are paid.
- Social services like meals on wheels can be used.
-Most is not medical care , but rather assistance with ADL’s
What are the good things brought in by the ACA?
Insurance reforms:
- Prohibit use of “pre-existing conditions”
- Children/Depends can stay on parent’s insurance until age 26
- No lifetime limits
- No dropping sick pt’s allowed by insurance companies
- No copay for wellness checks (pap smears, etc)
What does case management do?
- Transitions between care
- Works with the entire healthcare team to meet PT needs
- Reviews charts and resources to ensure proper PT care
- Expert on public and private insurance reimbursement policies
- Facilitate admission and discharge process
What are clinical/critical pathways?
Map the focuses on treatments and outcomes for the illness/issue/disease.
What is a variance and what are the types?
Patient does not follow the approved critical pathway.
Patient variance ex: PT does not take medication
Provider variance ex: MD does not prescribe Rx
System (hospital) variance ex: Testing machine broken
Community variance ex:
-PT about o be discharged however, cannot return to nursing home because it’s Sunday and not open so they have to wait until Monday.
What is the Clinical/Critical pathway for CVA?
- Head CT within 10 minutes of arrival
- NIH stroke scale is completed within 15 minutes
- Fingerstick glucose and EKG completed within 30 minutes
- Weight patient
- TPA within 60 minutes
- Nurse perform bedside swallow evaluation by day 2
- ) DC telemetry by day 3
- ) Notify PT/family of stroke education class
What is Evidence Based Practice?
-Use of current best evidence in making decisions about client care
What are the steps to evidence based practice?
- Ask question
- Search
- Critically appraise
- Implement
- Evaluate
What is collaborative/interdisciplinary management?
Interaction of two or more health professionals, who bring their unique skills and knowledge to assist patients/clients and families with health decisions.
What is Risk Management?
Process of reducing or financing the cost of predictable losses; example: CAUTI
Includes identification, evaluation, and treatment of possible and actual risk situations to reduce change of loss
Incident report/occurence report used a documentation tool NOT part of PT record
What is continuous quality improvement (CQI)?
- Evaluates outcomes of care
- Ensures each PT receives predetermined high quality standard of care
- Similar to the nursing process (Plan, Do, Check, Act) with the focus on evaluation
What is the joint commission and what do they cover? Describe them.
Accrediting agency for healthcare facility
- Certification
- National Patient Safety Goals (Identify PT’s correctly with two identifiers, Use Rx’s safely, Prevent mistakes in Sx, Prevent infection)
- Sentinel Events (safety event that results in PT death, severe temporary or permanent harm, root analysis to determine what went wrong)
- Core Measures (“Recipe’s” for certain illnesses, essentially critical pathway from JC)
What are the ANA standards of practice?
(Same as the nursing process)
- Assessment
- Diagnosis
- Outcomes Identification
- Planning
- Evaluation
What is magnet status?
An Award by American Nurses Credentialing Center (ANCC)
These hospitals deliver:
- Excellent PT outcomes
- High level job satisfaction
- Low nurse turnover rate
- Appropriate grievance resolution
What does the IHI (Institute of Healthcare Improvement) do?
- Creates:
- [Bundles]
- Rapid response team
- Evidenced based care
What are Bundles?
3-5 steps that go with a specific PT care intervention
What is the central line bundle?
- Hand hygiene
- Maximal barrier precautions on insertion
- Chlorehexidine over Betadine
- Optimal site selection
- Daily review of Central Lines and Prompt Removal
