Healthcare Delivery System Practice Flashcards

Vocabulary flashcards covering the NUR 112 Healthcare Delivery System lecture, including regulatory agencies, level of care, health policy, and economic trends in nursing.

Health Insurance Portability and Accountability Act (HIPAA)

Ensures the confidentiality of health insurance and promotes methods to maintain the privacy of protected health information (PHI); violations are subject to a $250,000$ fine or $10$ years of jail time.

Health Policy

Goals, decisions, and actions that determine how health care is accessed and administered, functioning as guidelines that benefit the healthcare system, organizations, and patients.

Americans with Disabilities Act (ADA)

A federal health policy that protects people with disabilities against discrimination.

Healthy People 2030

A national goal to use health policy to prevent disease and improve health.

Nurse Practice Acts

State legislation that determines the scope of practice, educational requirements, and disciplinary authority for boards of nursing.

Boards of Nursing

Regulatory bodies that establish rules regarding delegation, medication administration, unprofessional conduct, and licensing.

Accreditation

A voluntary process providing verification that educational programs comply with established criteria and encourage evidence-based practices.

The Joint Commission

An independent, nonprofit agency and global leader in health care administration focused on assessing healthcare facilities in patient care and safety.

National Patient Safety Goals

Joint Commission standards aimed at identifying patients, improving communication, using medications safely, preventing infection, identifying safety risks, and preventing surgical mistakes.

Professional Organizations

Entities like the ANA and NLN that set standards for education/practice, influence legislation, and allow nurses to network and monitor current trends.

Quality Improvement

Systematic actions designed to result in measurable improvements in the health services and status of patient groups.

PDSA Cycle

An improvement model consisting of Plan (set goals), Do (carry out the plan), Study (analyze results), and Act (adopt, adapt, or abandon).

Standards of Care

A baseline for quality care in nursing that outlines professional expectations and proper protocols (e.g., Assessment, Diagnosis, Implementation).

Managed Care (HMOs/PPOs)

A healthcare framework where individuals select providers within a specific network.

Case Management

A model where a case manager leads an interdisciplinary team when services are required from multiple providers.

Patient-focused Care

A framework where healthcare is organized around the expressed physical and emotional needs of the patient.

Social Determinants of Health

The conditions in which people are born, grow, work, live, and age that impact health (e.g., economic stability, physical environment, education).

Uninsured

Having no healthcare coverage, often due to an employer not offering insurance or inability to afford private coverage.

Underinsured

Having healthcare coverage that is insufficient to meet individual needs, such as lacking drug coverage.

EMTALA (Emergency Medical Treatment and Active Labor Act)

Enacted in $1986$ to ensure public access to emergency services regardless of ability to pay; requires screening and stabilization of all patients.

Preventative Care

Education and activities to control risk factors and reduce disease incidence (e.g., stress management, immunizations, seat belt safety).

Primary Health Care

Diagnostic, therapeutic, and health education services provided in community centers or doctor's offices (e.g., prenatal care, nutritional counseling).

Secondary Health Care

Diagnosing and treating acute illness through short-term consultations with specialists (e.g., hospitals, urgent care centers).

Tertiary Care

Acute or highly specialized care for uncommon conditions (e.g., oncology centers, intensive care, burn centers).

Restorative Health Care

Intermediate follow-up for promoting self-care and restoring health (e.g., rehabilitation centers, home health, skilled nursing facilities).

Continuing Health Care

Chronic or long-term health care (e.g., adult day care, end of life care, assisted living, palliative care).

Ambulatory Care

Medical care that does not require overnight hospitalization; includes outpatient surgery and diagnostic imaging.

Cost Effective Care

Achieving the necessary health care result with minimal expenditure of dollars, time, and other resources.

DRGs (Diagnosis-Related Groups)

A government financing method that establishes reimbursement based on the patient's primary diagnosis.

Healthcare-Associated Infections (HAIs)

Medical errors including CAUTI, SSI, CLABSI, VAP, and C. diff infection that occur during treatment.

Informatics

The use of technology as an information gathering and communication tool to support evidence-based practice and clinical decision-making.

Affordable Care Act (ACA)

Legislation aimed at controlling costs, ensuring quality and equal access, and providing coverage for those with pre-existing conditions.