health care system

challenges of health care

• insurance

• improving access

• reducing costs

• maintaining safety

levels of health care

• preventative

• primary

• secondary

• tertiary

• restorative

• continuing care

preventative level

• reduce risks

• screenings, check ups, counseling

primary care

• improve health outcomes

• health care visits, education, maternal/child health care, family planning

places for primary care

• school health

• occupational health - work place

• physicians office

• nurse managed clinic

• block and parish - older patients

• community centers

secondary care

• provided by specialist or on referral by PCP

• focus on diagnosis and treatment

tertiary care

specialized consultative care, referral from secondary medical personnel needed (cardiologist, surgeons etc)

secondary/tertiary locations

• hospitals

• intensive care

• mental health facilities

• rural hospitals

when does discharge planning happen

• starts at admission

• determine post hospital destination and what they might need

what is restorative care

is the continuation of recover and support of chronic conditions

• for patients recovering from acute/chronic illness

restorative care types

• home care - includes: education, illness prevention, treatment, palliative care, rehab

• rehab - helps maintain/improve skills + functions for ADLs

• extended care - provide prolonged care for people with chronic diseases during rehab

continuing care

provides care for people who need help with ADLs

continuing care places

• nursing centers

• assisted living

• respite care

• adult day care

• palliative/hospice

nursing care center

• provide 24 hour intermediate/custodial care

• nursing, rehab, diet, social, recreational services

assisted living

• long term care

• resembles home environment

• more autonomy for patient

respite care

short term relief for family providing home care

adult day care

drop patient off for the day, social and health services

palliative and hospice care

palliative - patient centered care with goal of improving quality of life

hospice - palliative but regulated — need to be at end of life, under 6 months

hospital value based purchasing

provide higher care at less cost

hospital readmissions reduction program

reduce admissions within the 30 day window bc you don’t get money for those

bundled payments for care

set amount of money given to hospital for certain diagnoses

hospital acquired condition reduction program

no money if patient gets hospital acquired condition

QSEN competencies

• patient centered care

• team work and collaboration

• EBP

• quality improvement

• safety

• informatics

• leadership

what is patient centered care

• respect patient values

• coordinate care

• physical comfort

• access to care

• involvement of friends/family

• information/education

magnet program

recognizes excellence in nursing

• transformational leadership

• structural empowerment

• exemplary professional practice

• new knowledge, innovation + improvements

• empirical quality results