Lesson 3 - health care delivery

affordable care act

2010 law, improving health care quality while lowering its cost

regulatory agencies in health care

enforce standards and practice requirements that play a major role in the quality and costs of care delivered

federal agencies

medicare(over 65)/medicaid(low income individuals)

state agencies

board of nursing, tenncare

joint Commission Agency

independent nonprofit organization that accredits health care organizations based on patient safety

sentinel event

one that results in client death or permanent/severe temporary harm

National Committee for Quality Assurance (NCQA)

A private not-for-profit accreditation organization whose mission is to evaluate and report on the quality of managed care organizations in the United States(client satisfaction)

magnet status

awarded when organizations successfully demonstrate better client quality indicators

pathway to excellence program

-A four-year designation awarded to organizations that demonstrate commitment to providing a healthy workplace for their staff.

-Pathway standards focus on factors such as turnover, workplace engagement, productivity, teamwork, and job satisfaction.

-The Pathway application and review process involves frontline staff and organization leaders completing the application to determine if the standards are integrated into practice as well as the organizational culture

hospital consumer assessment of health care providers and systems

A broad range of standardized questions to measure and compare client satisfaction between healthcare facilities

press ganey

for clinics, usually, a survey tool based on client satisfaction

insurance reimbursement fee for service

Providers and organizations receive payment based on the volume of services provided, leads to skyrocketing in health care costs

diagnosis related groups

Predetermined payment structure for health care services established by the federal government (clients grouped based on specific drg and facilities receive a fixed cost)

resource utilization groups

long term care payment system

minimum data sets

evaluates information such as cognitive status of the client, need for assistance with adls, number of treatments and therapies etc.

social determinants of health

economic stability, education, social and community context, neighborhood and built environment, health and health care

physical determinants of health

related to physical environment - corwded dwellings, pollution, etc.

primary

prevention

secondary

early detection

tertiary

treatment after diagnosis

acute care setting

hospital

long term care facility

nursing home, rehab

long term care hospital

medical reason to remain in hospital

hospice care

patient is diagnosed with 6 months or less to live (end of life care)

palliative care

helps people with chronic illness, to decrease number of hospital admissions

respite care

break for primary care giver