intro: chapters 11 + 12

what are the IOM's 6 outcomes for a new health system for the 21st century?

- safe

- effective: an example of misuse is drawing labs for a terminally ill patient without taking any action based on the results

- efficient

- patient-centered

- timely

- equitable: care that maintains consistent quality, regardless of factors like socioeconomic status

the big-picture goals of health care is to…

• increase _____

• increase ….

• decrease ____

• access

• quality of care/patient safety

• cost

the IHI triple aim consists of what 3 things?

access, cost, and quality

what are some things that limit/increase access to health care? (LAST)

- Patient Protection and Affordable Care Act (PPACA)

- Health Insurance Marketplace

- shortage of providers

- legislation addressing health care access

- caring for persons who are undocumented

explain the goals of the Patient Protection and Affordable Care Act (PPACA) (Obama care) (LAST)

- expand coverage, control health care costs, and improve the health care delivery system

- provide Medicaid to qualifying people w/ income up to 400% of poverty, beginning in 2014

- offer an easier way for individuals and families to find and purchase affordable health insurance that meets their needs and budget

examples of things hospitals need to be better about:

1. ______ ______ prevention

2. ________ prevention

3. surgical _____ infection prevention

4. ____ hygiene: goal is ___% compliance

5. length of _____

6. readmission prevention: none within ___ days

7. ____ reduction

8. experience of _____

1. c. diff

2. CAUDI

3. surgical

4. hand, 100

5. stay

6. 30 days (bc insurance won’t cover it)

7. mortality

8. care

define medicare:

federal government funded insurance for those 65 and older. you have to have worked 10,000 taxable hours

multi-payer system:

when multiple entities share the cost of payment (ex the government)

single-payer system:

a single entity that covers all costs (i.e. Medicare or Veterans health admin)

diagnosis-related groups (DRGs):

how Medicare decides how much to pay for each healthcare cost, incudes everything it takes to take care of that patient

resource utilization groups (RUGs):

drives Medicare reimbursements to nursing homes based on the level of care needed

primary health care involves treatment of…

common health problems (diabetes, flu, arthritis)

secondary health care involves treatment of…

problems requiring more specialized clinical expertise (MI or stroke)

tertiary health care involves…

management of rare and complex disorders

1. a not for profit hospital is…

2. a for profit hospital is…

3. are most providers not for profit or for profit?

1. required to take all patients

2. not required to take all patients

3. for profit

multispecialty group practices:

health care practices that consist of multiple specialties working together to provide comprehensive care to patients

community health centers:

local health care facilities that provide primary care services, often focusing on underserved populations

prepaid group practice:

a health care delivery model where patients pay a fixed, prepaid amount for a range of health care services

HMOs (health maintenance organizations):

1. Does pt have to have a PCP?

2. Are referrals required?

3. Is out of network coverage provided?

4. Is cost lower or higher?

5. Flexibility?

1. Yes

2. Yes

3. Emergencies only

4. Lower

5. Limited

PPOs (preferred provider organizations):

1. Does pt have to have a PCP?

2. Are referrals required?

3. Is out of network coverage provided?

4. Is cost lower or higher?

5. Flexibility?

1. No

2. No

3. Yes but at a higher cost

4. Higher

5. High

also have easier access to to specialists

higher reimbursement rates are typically paid for both HMOs and PPOs. why?

because these plans manage a large network of providers and offer better-cost control options

accountable care organizations (ACOs):

groups of healthcare providers who come together to coordinate care for Medicare patients to improve quality and reduce costs

define "medical homes to medical neighborhoods"

Medical Home = Your home base for care (your primary doctor).

Medical Neighborhood = specialists, hospitals, pharmacies, behavioral health, rehab, and other providers all coming together to help you

Ways to pay for health care:

1. out of pocket payment:

2. individual private insurance:

3. employer-based private insurance (most common):

4. government financing includes…

1. pt pays healthcare services at the time they are provided w/o insurance assistance

2. insurance purchased directly by individuals from insurance providers

3. insurance offered to employees as a benefit, often covering both the employee and their family members

4. Medicare (uses DRGs), Medicaid, Children's Health Insurance Program (CHIP), Veterans Health Administration (VHA)

1. Medicaid is given to…

2. Who is CHIP for?

1. disabled people, families w/ dependent children, or low income ppl with children

2. families with low income that aren’t eligible for medicaid that get help for their children

health care settings:

1. hospitals:

2. primary care centers:

3. ambulatory care centers and clinics:

4. home health care:

5. extended care services:

6. specialized care centers and settings:

7. health care services for the seriously ill and dying:

1. hospitals: provide emergency care, surgeries, and inpatient services for serious conditions

2. primary care centers: offer routine care for minor illnesses and surgeries

3. ambulatory care centers and clinics: provide outpatient services like diagnostic tests and minor procedures

4. home health care: at home for recovery or chronic conditions

5. extended care services: long-term care in nursing homes or assisted living

6. specialized care centers and settings: focus on specific conditions like cancer or heart disease

7. health care services for the seriously ill and dying: hospice and palliative care to manage pain and provide comfort for terminally ill patients

what are some roles of nurses in primary care centers? (4)

- Advanced Practice Registered Nurses (APRNs)

- nurse practitioners

- midwives

- clinical nurse specialists

true or false: nurses can work independently or with physicians to assess and care for patients, focusing on health maintenance and promotion

true

depending on ____ ____ , APRNs may operate their own offices or clinics, providing primary care and treatment, and only referring complex health issues to physicians

state regulations

what is the most rapidly growing area of the health care system?

home health care

home health care is driven by a _____ system of _____, which encourages…

• payment

• system

• early discharge from hospitals

services of home health care:

1. skilled _____ assessment

2. administration of _______

3. _____ and ______ of patients and family members

4. _____ ______ for patients

1. nursing

2. medications

3. teaching and support

4. direct care

1. what do extended-care facilities provide?

2. what are some examples of extended-care facilities? (LAST)

1. both medical and non medical care for people with chronic disabilities

2. -transitional subacute care

   -assisted-living facilities

   -intermediate and long-term care

   -homes for medically fragile children

   -retirement centers

   -residential institutions for mentally or physically disabled

   -senior retirement communities

"aging in place":

a model that allows seniors to live in their own homes with appropriate support and services as they age

what are some examples of specialized care centers and settings? (LAST)

- daycare centers

- mental health centers

- rural health centers

- schools

- industry: workplace health services that address employee wellness, injury prevention, and occupational health

- homeless shelters

- rehabilitation centers

• certified extended care services:

• non-certified extended care services:

- meet government standards, are eligible for reimbursements, and are regularly inspected

- do not meet regulatory standards, may not qualify for reimbursements, and often require private payments

parish nursing:

providing holistic care within faith communities, focusing on physical, emotional, and spiritual well-being

respite care:

provides temporary relief for caregivers of homebound, ill, or disabled adults, giving them time away from daily caregiving responsibilities

hospice services:

- focuses on comprehensive care for individuals nearing the end of life (with a prognosis of 6 months or less)

- offers medications, supplies, equipment, family education, and counseling

palliative care:

- available at any stage of illness, not just end-of-life care

- focuses on symptom management instead of curative treatment, and does not require a prognosis of 6 months or less

1. voluntary agencies in healthcare include ______ ______.

2. what do they do?

1. support groups

2. provide emotional support, information, and resources for individuals dealing with specific health conditions

government healthcare agencies:

• public health service:

• CDC:

• public health facilities:

• Public Health Service: a branch of the government focused on improving the nation's health through programs, research, and policy

• CDC: a federal agency that protects public health by controlling and preventing disease outbreaks

• Public Health Facilities: government-ran facilities offering education, prevention, and care for poorer communities

who all is involved in the health care team (collaborative care)? (LAST)

- physician, physician assistant, APRN

- nurse, assistive personnel

- physical, occupational, speech, and respiratory therapist

- dietitian

- pharmacist

- chaplain / spiritual care provider

trends to watch in health care delivery:

• focus on _______ care

• ______ and _______ consumers

• _____ health

• ____ justice and ____

• preventive

• knowledgeable and engaged

• mobile

• racial and equity

more nurses are advancing their education, becoming ____ , ____ , or earning ____ , enhancing their expertise and ability to lead in healthcare

- APRNs

- DNPs

- PhDs

nurses are becoming a ____ ____ in addressing national health challenges and proposing effective solutions

stronger voice

hospitalist:

- a physician who specializes in the care of only hospitalized patients

- they typically have board certification in hospital medicine and focus solely on inpatient care. they don’t see pts after discharge

define fragmented care and discuss its causes and resulting implications

disconnected care due to poor coordination, leading to medication errors, missed diagnoses, and worse outcomes, increasing healthcare costs

define HCAPS

a survey measuring patient satisfaction with hospital care, impacting reimbursement rates

- fee for service:

- pay for performance:

- fee for service: providers are paid per service or procedure performed

- pay for performance: providers are reimbursed based on the quality and outcomes of care, not service volume

*rounding will not occur until calculation of ____ ____

final grades

*all final course grades of ____ or higher will be rounded to the next highest whole number

XX.5

*a minimum average of ____ must be achieved on a course exams, before any other points in the course will be considered. for undergraduate nursing students, ____ is the minimum score in order to achieve a passing grade in all nursing course

75%

*how many times can a nursing course be repeated?

one time

*____ nursing course grades of C-, D, or F will require withdrawal from the program, even if one course is repeated with a passing grade

two

*if either the didactic or clinical component is failed what happens?

both must be retaken

*unsatisfactory clinical performance will result in an ____ , regardless of any grades related to the theoretical component of the course, and if behavior jeopardizes client safety, the student must what?

- F

- withdraw from the program

freebie

woop

Which is the largest single source of reimbursement for home health care services?

• Medicare

• Client's self-pay

• Private insurance

• Medicaid

Medicare

do we ask immigrants what their status is?

no bc its not our place. we give them the same quality of care as everyone else