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Fundamentals of Nursing: The Health Care Delivery System chapter 2
Terms in this set (77)
Challenges to Health Care
a. Uninsured Patients
b. Reducing health care costs while maintaining high-quality care for patients
c. Improving access and coverage for more people
d. Encouraging healthy behaviors
e. Earlier hospital discharges result in more patients needed nursing home and home care
National Priorities Partnership: (6)
a group of 52 organizations, from a variety of health care disciplines, that have joined together to work toward transforming health care with the aims of healthy people and healthy communities and better and affordable care.
- *Promote best practices
- Promote prevention, treatment, and intervention practices for the leading causes of mortality
- Ensure person and family-centered care
- Make care safer
- Promote communication and care coordination
- Make quality care affordable*
The Institute of Medicine (2011) vision to transform health care delivery states that nurses need: (4)
a. To practice to the full extent of their education and training.
b. To achieve high levels of education and training through an education system that provides seamless progression.
c. To become full partners, with physicians and other health care providers in redesigning the health care system.
d. To improve data collection and information infrastructure for effective workforce planning and policy making.
Professional standards review organizations (PSROs)
Review the quality, quantity, and cost of hospital care.
Utilization Review (UR) committees
Review the admissions and identify and eliminate overuse of diagnostic and treatment services.
Prospective payment system (PPS)
Eliminated cost-based reimbursement
Diagnosis-related groups (DRGs)
Hospitals receive a set dollar amount based on an assigned group.
Providers receive a fixed amount per patient.
Resource utilization groups (RUGs)
Used in long-term care.
Instead of setting up private practices, joining big corporations (less money & more profit)
Provider or health care system receives a predetermined capitated payment for each patient.
"Never Events" (7)
Sentinel events and requires a root cause analysis following the event
2. Product or device
3. Patient Protection
4. Care Management
Patient Protection and Affordable Care Act
- Access to health care for all
- Reducing costs
- Improving quality
- Provisions include
(Insurance industry reforms, Increased funding for public programs, Improved coverage for children)
Examples of Health Care Plans: Table 2.1 (7)
- Managed Care Organization (MCO)
- Preferred provider organization (PPO)
- Private Insurance
- Long-Term Care (LTC) Insurance
- State Children's Health Insurance Program (SCHIP)
The emphasis of health care industry today is shifting from managing ___ to managing ___.
Illness; health of a community and the environment.
Explain what integrated delivery networks (IDNs) are.
Include a set of providers and services organized to deliver a continuum of care to a population of patients at a capitated cost in a particular setting.
Health Services Pyramid:
reduces and controls risk factors for disease
- Blood pressure and cancer screening, immunizations, Mental health counseling and crisis prevention, Community legislation (e.g. seat belts, air bags, bike helmets, no texting while driving).
Primary care (health promotion)
Focuses on improved health outcomes
- Prenatal and well-baby care; Nutrition counseling; Family planning; Exercise, yoga, and mediation classes.
Health Promotion Programs lower overall costs:
- Reduces incidence of disease
- Minimizes complications
- Reduces the need for more expensive resources
Secondary and Tertiary Care
Focus: Diagnosis and treatment of disease
- Disease management is the most common and expensive service of the health care delivery system
- Postponement of care by uninsured contributes to high costs
Emergency care, Acute medical-surgical care, Radiological procedures for acute problems (e.g. x-rays, computed tomography [CT] scans).
Intensive care, Subacute care
- Serves patients recovering from an acute or chronic illness/disability
- Helps individuals regain maximal function and enhance quality of life
Examples of Restorative Care:
Cardiovascular and pulmonary rehabilitation, Orthopedic rehabilitation, Sports medicine, Spinal cord injury programs, Home care
Restorative Care: Home Health Care
Provision of medically related services and equipment to patients and families in their homes for health maintenance, education, illness prevention, diagnosis and treatment of disease, palliation, and rehabilitation.
- Involves coordination of services.
- Focuses on patient and family independence.
- Usually reimbursed by government, private insurance, and private pay.
Restorative Care: Rehabilitation
Includes physical, occupational, and speech therapy, and social services
- Begins on admission
- Focuses on preventing complications
- Maximizes patient function and independence
Restorative Care: Extended Care
- Extended Care Facility
- Intermediate care/skilled nursing facility
Intermediate care/skilled nursing facility:
Provides care for patients until they can return to their community or residential care location
Explain the difference between:
Primary health care
- Primary care focuses on health outcomes for an
. Health promotion programs lower the overall costs of health care., reducing the incidence of disease, minimizing complications, and reducing the need to use more expensive health care resources.
- Preventative care is more
and focused on reducing and controlling risk factors for disease through activities. (immunizations and occupational health programs)
Preventative and Primary Care Services: (6)
- School Health
- Occupational Heath
- Physicians' Offices
- Nurse-manages clinics
- Block and parish nursing
- Community health centers
Disease management is:
is the most common and expensive service of the health care delivery system.
Give some examples of acute care facilities.
a. Emergency departments
b. Urgent care centers
c. Critical care units
d. Medical-surgical units
Because of _______________, more services are available on nursing units, thus minimizing the need to transfer and transport patients across multiple areas.
Discharge planning begins:
the moment a patient is admitted to a health care facility.
____ is a centralized, coordinated, multidisciplinary process that ensures that the patient has a plan for continuing care after leaving the health care agency.
List the tips on making a referral process.
a.Make a referral as soon as possible
b. Give the receiving provider as much information as possible about the patient.
c. Involve the patient and family in the process
d. Determine what the care provider receiving the referral recommends for the patient's care.
Identify the instructions needed before patients leave health care facilities.
a. Safe and effective use of medications and medical equipment.
b. Instruction and counseling on food-drug interactions, nutrition, and modified diets.
c. Rehabilitation techniques
d. Access to appropriate community resources
e. When and how to obtain further treatment
f. The responsibilities of the patient and the families with ongoing health care needs.
g. When to notify their health care provider for changes in functioning or new symptoms.
Identify the two reasons why an intensive care unit (ICU) is the most expensive health care delivery site.
a. Usually nurses care for only one to two patients at a time.
b. Treatments and procedures required.
The goal of restorative care is:
to help individuals
regain maximal functional status
and to enhance quality of life through promotion of independence and self-care.
Home care services include:
b. Medical and social services
c. Physical, occupational, speech, and respiratory therapy
d. Nutritional therapy
Give some examples of home nursing care.
a. Monitoring vital signs
b. Administration of parenteral or enteral nutrition, and medications.
c. IV or blood therapy
d. Wound care
e. Respiratory care
_____ restores a person to the fullest physical, mental, social, vocational, and economic potential possible.
Extended care facility
Include immediate care and skilled nursing facilities.
Services are for people who are disabled, not functionally independent or who suffer a terminal disease.
24-hour intermediate and custodial care
Long-term care setting with greater resident autonomy.
Provides short-term relief to the family members who care for the patient.
Adult day care center
Allows patients to retain more independence by living at home.
Focus of care is palliative, not curative, treatment.
Accountable Care Organization (ACO):
Developed to coordinate medical care by primary care and specialty physicians, hospitals, and other health care providers, with the goal of providing high-quality coordinated care.
Patient-centered medical home (PCMH):
Make care for patients more efficient, effective, continuous, comprehensive, patient-centered, and coordinated.
Issues in Health Care Delivery:
- Nursing shortage
- Quality and safety in health care (Pay for performance, Patient satisfaction)
- Magnet Recognition Program (Nursing-sensitive outcomes)
- Nursing informatics & technological advancements
- Globalization of Health Care (Vulnerable Populations)
List some of the factors that are contributing to a nursing shortage.
Aging baby-boomer generation, slow growth in nursing school enrollments, nursing facility shortages, space limitations, and clinical site availability.
Provide patient-centered care
Recognize and respect differences in patients' values, preferences, and needs; relieve pain and suffering; coordinate continuous care; communicate with and educate patients.
Work in interdisciplinary teams
Cooperate, collaborate, and communicate; integrate care to ensure that it is continuous and reliable.
Use evidence-based practice
Integrate best research with clinical practice, practice in research activities.
Apply quality improvement
Identify errors and hazards in care; practice using basic safety design principles; measure quality in relation to structure, process, and outcomes; design and test interventions to change processes.
Information technology to communicate, manage knowledge, reduce error, and support decision-making.
List the 10 rules of performance in a redesigned health care system.
a. Care is based on continuous healing relationships.
b. Care is individualized based on patient needs and values.
c. The patient is the source of control, participating in shared decision making.
d. knowledge is shared.
e. Decision making is evidence based.
f. Safety is a system property and focused on reducing errors.
g. Transparency through sharing information
h. Needs are anticipated through planning.
i. Waste is continuously decreased.
j. Cooperation and communication among clinicians are priorities.
Quality health care is:
The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.
The goal of pay for performance programs is:
to reward excellence through financial incentives to motivate change to achieve measurable improvements.
Hospital Consumer of Assessment of Healthcare Providers and Systems (HCAHPS) is:
a standardized survey developed to measure patient perceptions of their hospital experience.
Concepts of patient-centered care include:
a. Respect and dignity
b. Sharing of information
c. Participation in care and care decisions
Health care organizations that apply for Magnet status must demonstrate
a. Quality patient care
b. Nursing excellence
c. Innovations in professional practice
The revised Magnet model has five components affected by global issues: please identify.
a. Transformational leadership
b. Structural empowerment
c. Exemplary professional practice
d. New knowledge, innovation, and improvements
e. Empirical quality results
Explain nurse-sensitive outcomes and give some examples.
are patient outcomes and select nursing workforce characteristics that are directly related to nursing. Examples include changes in patient symptom experiences, functional status, safety, psychological distress, RN job satisfaction, total nursing hours per patient day, and costs.
_____ uses information and technology to communicate, manage knowledge, mitigate error, and support decision making.
Increased connectedness of the world's economy, culture, and technology.
Vulnerable populations are identified as (3)
c. Older adults
Quality improvement (QI)
is an approach to the continuous study and improvement of the processes of providing health care services to meet the needs of patients and others to inform health care policy.
Performance improvement (PI)
Organization analyzes and evaluates current performance and uses the results to develop focused improvement actions.
The PDSA cycle:
is a model for quality and performance improvement.
- Plan—review available data to understand existing practice conditions or problems to identify the need for change;
- Do—select an intervention on the basis of the data reviewed and implement the change;
- Study—study (evaluate) the results of the change;
- Act—if the process change is successful with positive outcomes, act on the practices by incorporating them into daily unit performance.
Health promotion programs are designed to help patients:
1. Reduce the incidence of disease.
2. Maintain maximal function
3. Reduce the need to use more expensive health care services.
4. All of the above
4. all of the above
Reduce the incidence of disease, minimize complications, and reduce the need to use more expensive health care resources.
Rehabilitation services begin:
1. When the patient enters the health care system.
2. After the patient's physical condition stabilizes
3. After the patient requests rehabilitation services.
4. When the patient is discharged from the hospital.
1. When the patient enters the health care system.
Initially focuses on the prevention of complications related to the illness or injury. After the condition stabilizes, rehabilitation helps to maximize the patient's level of independence.
An example of an extended care facility is a:
1. Home care agency
2. Skilled nursing facility
3. Suicide prevention center
4. State-owned psychiatric hospital
2. Skilled nursing facility
Where they receive supportive care until they are able to move back into the community.
A patient and his or her family facing the end stages of a terminal illness might best be served by a:
2. Rehabilitation center
3. Extended care facility
4. Crisis intervention center
The focus is on palliative care, not currative treatment.
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