HK 418 Exam 1

health

a state of complete physical, mental, and social well-being, and not merely the absence of disease and infirmity

care

set of relational actions that take place in an institutional context and aim to maintain, improve or restore well-being

primary care

basic, routine services provided on an outpatient basis in a doctor’s office by a variety of healthcare providers

secondary care

services requiring specialists with specific expertise; patients are typically referred from primary care provider

tertiary care

complex levels of treatment requiring advanced technologies

quarternary care

extension of tertiary care, but highly specialized/limited (e.g., experimental treatments)

micro-system

doctor, patient, and their relationship

macro-system

all the players beyond the immediate provision of care delivery (payers, insurers, providers, distributors, and suppliers)

societal system

social, economic, and physical environment

iron triangle

cost containment, access, and quality

quintuple aim

lowering cost, improving workforce well-being, improving care, population health, and advancing health equity

prices

total amount a provider or supplier requires as payment for healthcare item or service

costs

input costs of production (e.g., labor, overhead, energy, capital expenses, supplies, and equipment)

spending

total amount spent on healthcare (spending = price x utilization)

Which statement best describes how the cost of healthcare can be measured?

Healthcare cost can be measured in several ways, including national health expenditures, insurance premiums and deductibles, and household healthcare spending.

There is always the same trade-off between the quality and cost of healthcare – in order to improve quality, you have to increase costs. (T/F)

false

Which of the following are linked to access to care?

all of the above

A patient is referred by their family doctor to a dermatologist. The patient’s visit with the dermatologist is an example of:

secondary care

Which of the following is a component of the Quintuple Aim?

all of the above

Employers, Medicare, Medicaid, and individuals are examples of which component of the value chain of the U.S. healthcare system?

payers

A doctor examines a patient exhibiting shortness of breath and headaches. They diagnose the patient with high blood pressure and prescribe medication. Which of the following models of health and healthcare does this approach align with?

biomedical model

Sally has diabetes. When she boards a plane, she is allowed to board early because she needs extra time to organize her medical supplies and medications. What concept describes the social norms,  recognition, or treatment of a person because of their health condition?

sickness

Which of the following is one reason healthcare is not considered a normal consumer good?

Doctors have more knowledge of what healthcare services a patient will require.

“the health outcomes [life expectancy, functional status, health status] of a group of individuals, including the distribution of such outcomes within the group” refers to which of the following?

population health

Sally has diabetes. She feels frustrated because managing her diabetes requires her to check her blood sugar throughout the day and change what she eats. Her personal experience of living with this health condition is an example of which of the following: 

ilness

Individual behaviors are the sole determinant of a person's health status and outcomes. (T/F)

false

health

a state of complete physical, mental, and social well-being and not merely the absence of disease

well-being

an outcome of all the aspects of life coming together in a meaningful way

illness

a person experiences a loss (symptoms) of his/her health

sickness

the person takes and/or is given the social role regarding his/her condition

disease

the person calls for professional help and his/her condition is diagnosed by a medical expert (physician)

medicalization

the process by which personal, behavioral, and social issues are increasingly viewed through a biomedical lens and ‘diagnosed and treated’ as individual pathologies and problems

inpatient

patient is admitted to hospital for ongoing medical or surgical care (secondary, tertiary, or quaternary)

market consumerism

medicine is organized around providing more (and hopefully better) goods and services, like any consumer market

doctor shopping

a critical label for patients who seek out providers, diagnoses, tests, and treatments

consumer watchdog

expectation that every patient is a discerning critic of their own care (educated consumer)

commoditization

conversion of medical care from a highly personal set of services unique to each individual patient/physician relationship into a fungible commercial product available from a variety of vendors

biomedical model

focuses on biological causes of disease

biopsychosocial model

alongside biomedical factors, also considers patient experiences and behaviors (“psycho”), and social support network (e.g., family, friends, community

social/structural models

in life course, health is shaped by the interactions between individual, social, community level, and broader structural factors

social determinants of health

non-medical factors that affect health outcomes. They include the conditions in which people are born, grow, work, live, and age

population health

the health outcomes [life expectancy, functional status, health status] of a group of individuals, including the distribution of such outcomes within the group.

health equity

state in which everyone has a fair and just opportunity to attain their highest level of health

health disparity

[preventable] differences in the incidence, prevalence, mortality, and burden of disease and other adverse health conditions that exist among specific population groups in the United States

health inequity

differences which are unnecessary and avoidable, but in addition are considered unfair and unjust…the cause has to be examined and judged to be unfair in the context of what is going on in the rest of society

healthcare disparity

[preventable] difference between population groups in the way they access, experience, and receive healthcare

healthcare inequity

a healthcare disparity that is unfair and unjust

social risk factors

adverse social conditions associated with poor health, such as food insecurity and housing instability. This is about an individual's exposure to risk, distinct from SDOH (the systemic cause) and distinct from an immediate need.

health-related social need (HRSN)

a person’s current, specific unmet need requiring intervention right now

pitfalls of medicalization of population health

“denominator shrinkage”, downstream focus, and silence on upstream drivers

A state requires nurse practitioners (NPs) to have a career-long collaborative agreement with a physician in order to provide patient care. The NP can evaluate patients, diagnose conditions, order and interpret diagnostic tests, and prescribe medications, but cannot practice independently without the collaborative agreement.

Which category of scope-of-practice regulation does this state have?

reduced practice

A patient has several chronic health conditions and sees multiple specialists. What is one potential disadvantage of having many specialists involved in the patient's care?

The patient may have difficulty coordinating care across multiple providers.

A physician knows a patient needs more time and attention, but because of staffing shortages, she is forced to leave the patient without the care she believes they deserve. She later feels guilt and distress about the situation. What does this best illustrate?

moral injury

Which of the following is an example of a factor that increases the demand for healthcare workers, rather than a factor that reduces the supply of workers?

An aging population with increasing rates of chronic illness

Healthcare workforce shortages affect all parts of the U.S. equally. (T/F)

False

Which of the following best describes the role of a registered nurse (RN)?

Providing and coordinating patient care

healthcare provider

A licensed person or organization that provides health care services

physicians

diagnosis, assessment, and prescribing and performing treatment on patients (over 1 mil in 2023)

nurses

physical exams, health promotion, administering medications, coordinating care (over 4.1 mil in 2023)

registered nurses (RNs)

monitor, treat, and educate patients in their care

licensed practical nurses (LPNs) or licensed vocational nurses (LVNs)

offer assistance to RNs

nurse practicioners

medical providers who have been licensed to diagnose and treat illness and disease in collaboration with a licensed physician

clinical nurse specialist

nurses with advanced training in a specialized area of nursing

advanced practice professionals (APP)

Growing category of medical service provider that take on care delivery responsibilities previously performed by physicians, includes APRNs and PAs, practice authorities and responsibilities vary on a state level

supply

the health care workforce and the services it can provide

demand

the services patients or payers are willing and able to obtain through the health care market

need

the services required to achieve a desired level of health, regardless of whether patients can afford or access them

burnout

Emotional exhaustion, depersonalization, reduced accomplishment from chronic workplace stress. Implies the individual can no longer cope

moral injury

Psychological harm from being unable to provide care that aligns with one's values due to systemic constraints. Implies the system has failed the worker

common interventions for burnout/moral injury

PPE access, resiliency tools, improved telehealth, financial bonuses, workload management

outpatient/ambulatory

care provided without an overnight hospital stay (e.g., same-day surgery, diagnostic testing)

emergency

urgent, unscheduled care provided in the emergency department; often the entry point to an inpatient admission

post-acute

follow up-care after hospital stay (rehab, skilled nursing)

nonprofit hospitals

tax exempt, owned by municpality or not-for-profit organization

for-profit hospitals

not tax exempt, owned by shareholders, with the goal of making a profit from the facility’s operations

community benefit activities

increased public scrutiny into charitable practices of nonprofit hospitals

dual hierarchy in hospitals

hospitals manage organization and resources, while physicians have control over clinical decisions and patient care

integration

process of bringing previously separate healthcare organizations, professionals, services, or functions into closer organizational or operational coordination to provide more coordinated care and achieve shared goals

consolidation

scenarios where hospitals and other health care entities join together under common ownership through either a merger or acquisition

horizontal integration

consolidation between entities that offer the same or similar services

vertical integration

consolidatiom between entities that offer different services along the same supply chain

key non-hospital settings

federally qualified health centers, community health centers, urgent care centers, ambulatory surgery centers, retail clinics

community health centers (CHCs)

local, community-based clinics that provide healthcare to people no matter their income, insurance, or background

federally qualified health centers (FQHCs)

outpatient clinics that qualify for specific reimbursement systems under Medicare and Medicaid; funded by Health Resources and Service Administration

urgent care centers (UCCs)

A walk-in clinic that treats injuries or illnesses requiring prompt attention but not serious enough for an ED visit, typically offering extended hours without an appointment

ambulatory surgery centers

A freestanding facility, separate from a hospital, where surgical procedures not requiring an overnight stay are performed on an outpatient basis

retail clinics

A healthcare clinic located inside a retail setting (e.g., pharmacy, supermarket), typically staffed by nurse practitioners or physician assistants, that treats simple medical conditions and provides basic preventive care

fragmentation of care

independent settings with limited connection to primary care provider, more access points does not necessarily mean more coordinated care

Long-term care hospitals (LTCH)

hospitals that provide extended, hospital-level care for medically complex patients, still require hospital-level care, measured in week stays, not days

Inpatient Rehabilitation Facilities (IRF)

specialized facility or unit within acute care hospital providing intensive, multidisciplinary rehabilitation therapy, intensive therapy 3+ hours per day

skilled nursing facilities (SNF)

facility-based care providing short or long-term skilled nursing care and rehabilitation services; 24-hour medical support, less intensive than an IRF, short-term rehab patients and long-term residents who need ongoing care

home health agencies (HHA)

skilled nursing, therapy, and other clinical services delivered in a patient’s home, rather than in a facility, wound care, IV therapy, intermittent skilled care not 24-hour supervision

long-term care

variety of services designed to meet a person’s health or personal care needs when they can no longer perform everyday activities on their own

post-acute care

care is delivered across a range of settings that differ in intensity, location, and length of stay

end-of-life care

care provided to individuals who are near the end of life

hospice care

interdisciplinary care focused on comfort, dignity, and quality of life for patients nearing the end of life

palliative care

“specialized medical care that focuses on providing relief from pain and other symptoms of a serious illness.”

PAC fragmentation

many small, independent operators, seperate licensure and regulation, and different referral relationships

hospice eligibility

generally requires a physician-certified prognosis of 6 months or less to live, if the disease runs its normal course

hospice v. end-of-life care

hospice specifically requires stepping away from curative treatment; broader end-of-life/palliative care does not