HPRS 1201 StUDY GUIDE

primary prevention

avoids the development of a disease

- ex: health education, smoking cessation programs, immunication programs, and educational programs for pregnancy/employee safety

secondary prevention

focuses on early disease identification/detection which prevents progression of the disease

- ex: screening programs like high blood pressure testing, colonoscopies, and mammograms

tertiary prevention

reduces the impact of an already established disease by reducing disease related complications (focuses on rehabilitation and monitoring of diseased individuals)

- ex: a person w/ high blood pressure taking blood pressure meds

graying of the US population and impact on healthcare

US life expectancy continues to increase (increased "graying" of a population) -----> US will be confronted with more chronic health issues (as people age, more chronic health conditions develop which will require more use of the healthcare system)

Patient Bills of Rights (1973)

first Bill of Rights to be established to protect healthcare consumers in hospitals (protection of rights)

- states that the patient has the right to all information from the provider regarding any testing, diagnoses, and treatments.

- info must be provided in terms that the patient will be able to understand

medicare

implemented in 1965 to provide health care access to the elderly

medicaid

provides healthcare access to the poor

hospitalists (1996)

providers that focus specifically on the care of a patient when they are hospitalized

- the new type of provider recognized the need of providing quality hospital care

group insurance

a type of private insurance that anticipates that a large group of individuals will purchase insurance through their employer and the risk is spread among those paying individuals

public health functions

functions that provide services to the community

- targets population rather than individuals

- ex: child immunization programs, health screenings in school, substance abuse programs, STD control

American Medical Association (1847) (AMA)

when it was established for physicians, it was a driving force for the concept of private practice in medicine

Emergency Medical Treatment and Active Labor Act (EMTALA)

legislative act passed to ensure that consumers were not refused treatment for an emergenc life threatening situation

- eveery patient must be treated right, even if a patient cannot pay the bill

Agency for Healthcare Research and Quality (AHRQ)

a federal gov agency who is the primary source for quality delivery of health services

The Physician Compare Website

established to help consumers with research about their physicians. It also helps consumers find out which physicians accept Medicare, specialty, and location of their services

The Affordable Care Act

requires most US citizens and legal residents to purchase health insurance if they can afford it or pay a penalty

- also requires insurance companies to cover young adultso n their parents insurance until age 26, EVEN IF they're not a student, not living with parents, NOR depending on parents' taxes.

The Nursing Home Medicare website

publish data that will enable consumers to compare the quality of long term facilities' care

- state websites, summary of complaints of facilities, criminal violations

The Center for Medicare and Medicaid Innovation RESPONSIBILITIES

researching different payment and delivery systems, implementing a hospital reimbursement (based on hospital's percentage of preventable medicaid readmissions.)

duty to treat

any person deserves basic health care (US healthcare system principle)

Residential care facilities

provide around the clock social and personal care to the elderly, children, and others who cannot take care of themselves

- ex: drug rehabilitation, group homes, assisted living facilities

per capita (The US spends more per capita on healthcare than any other country worldwide)

per person

difference of life expectancy between male and female

females typically live longer than males

why does the US have a lower medical school graduate rate than other countries?

because the curriculum is very difficult AND the cost is very expensive

infant mortality rate

the number of deaths per 1000 live births occuring among the population of a designated area during the same calendar year

outpatient care centers

provide different types of services that can be obtained without staying overnight

- ex: kidney dialysis centers, mental health and substance abuse clinics, surgical and emergency centers

home healthcare services

One of the fastest growing components of the healthcare industry as a form of employment.

Surgical General

the US chief health educator who provides information on how to improve US health

- appointed by US president

US Public Health Service Public Corps

provide support to the Surgeon General

Food and Drug Administration

is responsible for advancing public health by helping speed innovations that make medicines and foods more effective, safer, and more affordable

Occupational Safety and Health Administration (OSHA)

established in 1970 to govern the workplace environment to ensure that employees have a safe and healthy environment

- employers have the general duty to provide a safe working environment for their employees

- ALL WORKSPACES (ex: building sites, restaurants, stores, medical facilities)

Local health departments

are the government organization that provides the most direct services to the population

- 3000 in US

- basic role is to provide direct public health services to their designated areas

- varies according to geographic location

- most are involved in communicable disease control

US Constitution state government role

is the primary role in health care for citizens

- licenses medical professions (ex: nurse, physician, dentist, any doctor)

National Institute of Health

federnal agency responsible for research towards preventing and curing disease

determinants or influences of health

influences that impact the status of an individual's health

physical environment determinants examples

pollutants, hazardous exposure at work, water contamination

social environment determinants examples

socioeconomic status (directly relates to the quality of health)

- individuals w/ a higher income level are less exposed to environmental risks and increase access to quality healthcare

lifestyle and personal behavior determinants

diet, exercise, sexual activity, stressful job

genetic factors or person's biology determinants/impact on health

predispose individuals to certain diseases

how do the determinants of health tie to the role of public health care / healthcare delivery system

public health focuses on the impact of the determinants of an individual's health; health education and preventitive activities are then provided to help consumers understand the negative impact of the determinants

The American Cancer Society, American Helath Association, and the American Lung Association have all active health promotion activities at the ____________, _______, and ________ levels.

national, state, local

epidemiologic surveillance

consists of monitoring disease outbreaks to develop public health intervention strategies to combat disease

role of social media in healthcare

social media has become a communication tool for patients, for providers, and a tool for healthcare education

The American Medical Association has recognized that ___________ should be treated as a disease and treated as such.

obesity

respite care

provide systematic relief to those caregivers who need a mental break

- also forestalls ill patient from being placed in a facility

- temporary care program

Employee Assistance Program (EAPs)

a type of occupational health program that was established in the 1970s as an intervention for employee drug and alcohol abuse

- expanded to other services (ex: tobacco cessation programs and mental health counseling and referrals)

certification of hospitals

enables them to obtain medicare and medicaid reimbursement

- mandated by The Department of Health and Human Services

- all hospitals that receive medicare and medicaid reimbursement must adhere to conditions of participation which emphasize patient health and safety

which groups of people are more likely to use hospital emergency rooms for their healthcare?

indigent population, the elderly, and the medicaid recipients (healthcare for the poor)

what does a typical hospice team include?

the clergy, social workers, physicians, and nurses

impatient services

typically focus on acute care which includes secondary and tertiary care levels that most likely require impatient care

long term care hospitals

focus on patients who stay on an average greater than 30 days

- ex: rehabilitation and chronic disease hospitals

urgent/emergent care centers

established in 1970s because they provided an opportunity for healthcare consumers who need medical care but the situation is not life threatening

Self Determination Act of 1990

requires hospitals that treat Medicare and Medicaid patients to provide information to the patients about their rights when they are admitted

Medical illustrators

trained artists that portray visually scientific information to teach both the professionals and the public about medical issues

certified nursing assistants (CNAs)

unlicensed patient attendants who work under the supervision of physicians and nurses

nurses constitute the _____________ group of health care professionals, provide the _______________ of care to patients, and represent %___ of the healthcare workforce.

largest, majority, %20

registered nurses can be licensed in more than one ____________.

state

Pharmacy Technicians responsibilities

counting tablets and measuring amounts of other medication for prescriptions, compound or mix medications, such as preparing ointments, and taking from customers or health professionals the information needed to fill a prescription

perfusionist

operates equipment to support or replace a patient's circulatory or respiratory function

physicians w/ Doctor of Osteopathic Medicine (DOs)

tend to stress preventative treatments and use a holistic approach to treating a patient which means they don't focus only on the disease but on the entire person

physicians w/ Doctors of Medicine (MDSs)

actively intervene in attacking and eradicating disease

flexible spending accounts (FSA)

provide employees with the option of setting aside pretax income to pay for out of pocket medical expenses

- employees must submit claims for these expenses and are reimbursed from their spending accounts

- drawback: amount set aside must be spent in one year

copayments

costs that the patient must pay at the time they receive the services (designated dollar amount)

medicare part A

primarily financed from payroll taxes

- employer and employee contribute to fund

- employee 1.5 percent of wages matched w/ employer

- self-employed individuals pay 2.9% of earnings

- covers hospital inpatient services, care in a skilled nursing facility, home health visits, and hospice care

- BENEFITS: hospitalization, skilled nursing facility services, some health and hospice are available prenium free to 65+ yrs

medicare part B

a supplemental health plan to cover physician services

- 24% financed from enrollee premiums and 76% from federal treasury funds

- BENEFITS: physician care, durable medical equipment, phycision ordered supplies, ambulatory surgical services, outpatient hospital care, outpatient mental health services, and laboratory services

- made available when enrollees sign up for Part A

medicare Part C

was designed to move medicare patients into more cost effective health insurance programs such as HMOs or PPOs

- voluntary and available when an individual enrolls in Parts A and B

- anti-fraud and abuse programs

- additional prevention programs for prostate cancer

- colorectal screenings and mammogrpahy

- rural initiatives and the establishment of the State's Children Health Insurance Program (SCHIP) for low income children

medicare Part D

purpose was to provide relief from costly prescription costs for seniors

- projected to nearly $750 billion in the first 10 years

- tax revnue from gov supports approx. 78% of the program costs (10% is financed through monthly premiums, 11% is financed by state payments, 1% from other sources)

- voluntary program because enrollees pay a premium for coverage

- BENEFITS: affordable prescription drug plans (advantage plan enrollees and traditional Medicare health plans)

- BENEFITS: seniors who are indigent can get a low income subsidy for the costs of Part D

the worker's compensation program

protects both the employer and employee if there is a job-related injury and illness

health insurance

developed to provide protection to an employee in the event they required health care, just like homeowner's insurance or life insurance

monetary contribution

required by most insurance policies from the covered individual that can include copayment, deductible, and coinsurance

fee for service (FFS)q

the traditional health insurance plan that paid a fee for provided service by the provider

- increased costs of healthcare throughout its history

managed care

refers to the cost management of health care services utilization by controlling who the consumer sees and how much the services costs

- two types: health maintenance organizations (HMOS) and preferred provider organizations (PPOS)

Health Maintenance Organization (HMO)

members must see their primary care provider in order to see a specialist

- oldest type of managed care

preferred provider organizations (PPOS)

no gatekeeper; a member does not need a referral to see a specialist

health information systems

systems that store, transmit, collect, and retrieve these data

- data STORED raw

health information technologys (HIT)

goal is to manage the health data that can be used by patients/consumers, insurance companies, health care providers, health care administrators and any stakeholder that has an interest in health care

- data MANAGED for health professionals

impact of health information technologys (HIT)

all stakeholders use HIT and has a tremendous impact on the healthcare industry because it allows documentation of everry transaction to be more quickly documented (increased management efficiency of healthcare data)

The general term of health or medical informatics refers to the:

the science of computer application that supports cclinical research data in different areas of healthcare

telehealth

the broad term that encompasses the use of information technology to deliver education, research and clinical care

- ex: use of email as a communication between providers and their patient

3 critical success factors for successful HIT implementation

1. All participants adopt the technology

2. Establishment of a reliable HIT infrastructure

3. Ongoing training for all employees

imaging informatics

applies computer technology to organs and tissue

informed consent

based on the patient's right to make an informed decision regarding medical treatment. It is the communication between the provider and patient regarding a specific medical treatment

- legal requirements in all 50 states

Consolidated Omnibus Budget Reconciliation Act of 1986 (COBRA)

was passed to protect employees who lost or changed employers (bosses) so that they could keep their health insurace if they paid 102% of the full premium

- amendment to ERISA

civil law

focuses on the wrongful acts against individuals and organizations based on contractual violations

- does not need as much evidence as a criminal case

torts

a category of wrongful acts, in civil law, which may not have a pre-existing contract

criminal law

concerned with actions that are illegal based on court decisions

- in order to convict someone, it has to be proven without a reasonable doubt of guilt

- ex: Medicare fraud, illegal abortions

American Medical Association (AMA) about legal contracts

once a patient and physician relationship has started, the physician is both legally and ethically obligated to continue the relationship until the patient no longer requires their care

- otherwise, the physician can be accused of "patient abandonment" if steps are not taken to properly end the relationship

patient abandonment

Terminating the relationship with the patient without giving reasonable notice or providing a competent replacement, resulting in a lack of necessary medical care (ITS IN THE NAME U DUMBO)

implied contracts

contracts that result from a physician's actions such as giving advice regarding medical treatment

- begins when a physician sees a patient in the office for the first time

medical ethics

focuses on the decisions health care providers make on the patient's medical treatment

- ex: euthanisia or physician assisted suicide

bioethics

a field of study concerned with the ehtics and its implications of certain biological and medical procedures and technologies

- ex: cloning, alternative reproductive methods (vitro fertilization, organ transplants, genetic engineering, care of the terminally ill)

stem cells

"starter" cells for the development of the body tissue which have yet to be formed into specialized tissues for certain parts of the body

- all human beings possess stem cells

according to Beauchamp and Childress (2001) and Gillon (1994), the role of ethics in the healthcare industry is based on five basic values that all healthcare providers should observe:

respect for autonomy, beneficence, non malfeasance, justice, dignity

respect for autonomy

decision making may be different and that helath care providers must respect their patients' decisions evne if they differ from their own

beneficence

the health care provider should have hte patient's best interests when making a decision

non malfeasance

the health care worker will cause no harm when taking action

justice

health care providers will make fair decisions and treat all patietns equally

dignity

patients should be treated with respect and dignity

elements of informed consent required for a research study

a written statement that includes the purpose and duration of the study, the procedures and duration of the study clearly defined, and any risks and benefits clearly defined

transplantation

the general procedure of implanting a functional organ from one person to another.

- ex: blood transfusions, heart or lung transplant

genetic testing

carried out on populations because it can be used for diagnosis for differrent diseases, assess risk factors for a genetic disease, and assess if the person has a carrier gene to pass onto their children

phycisian assisted suicide

when a physician writes a prescription fro the patient, enabling them to take their own life

- the patient will ultimately administer the lethal medication

- illegal in most states of US