Healthcare Delivery in the U.S. Exam 2

Exam 2 study guide

Mid-level Practitioner

a healthcare professional who is under a physician and can do the same things as a physician, often including diagnosing and treating patients, prescribing medications, and performing certain procedures. Examples include nurse practitioners and physician assistants.

geographic maldistribution

Physicians prefer urban or suburban areas leaving rural areas with shortage of medical professionals

specialty maldistribution

Physicians tend to choose specialty care physicians because they have higher pay and more control than being a primary/general care physician. This makes an imbalance of specialty and primary/general.

registered Nurse

comprehensive care, health education, and collaboration with other healthcare providers.

Licensed Practical Nurse 

more advanced care than CNA, basic diagnostic tests, and administrating medicine

Certified Nursing Assistant

Nurse that provides basic care to patients, 4-12 weeks, lowest level

Allied Health Professionals

diverse group of clinical professionals who provide a range of diagnostic, therapeutic, preventive, and rehabilitative services

What are the two types of physician degrees and what is the difference between them?

Doctor of Medicine (MD) and Doctor of Osteopathic Medicine (DO) and they are the same thing. Physicians prefer an MD because it is older and feels more prestigious

Can you identify some examples mid-level practices

nurse practitioner and physical therapist

can you identify some examples of allied health professionals

physical therapist and radiological technician

what does the hierarchy of nurse degree look like

1. advanced registered nurse

2. registered nurse

3. licensed nurse

4. cna

Health Service Managers

group of non-clinical professionals that plan, direct, and coordinate the business activities of healthcare providers

continuum of care

a collection of sequence or group of progression of values or elements varying by degree

what are the different settings of health services manager might work in

medical practice, entire facility, specific clinical area or department

what are the care types along the continuum of care

being healthy, ambulatory care, acute care, long term care, and end of life care

Primary care

First normal stop in healthcare could be for routine checkups, common illness, and chronic conditions…could see primary family physician or nurse practitioner

Secondary Care

Referral by primary care for a specific diagnosis/treatment…seeing a specialist like a cardiologist or dermatologist

Tertiary care

highly specialized care, often provided by hospitals or special facilities… includes advanced treatment like surgeries, intensive care, and specialized therapy

Quaternary Care

Even more specialized care and experiments…vary rare…majority will never experience it…most complex…experimental drugs

What are some examples of each level of care

Primary: family doctor Secondary: specialist (Biopsy) Tertiary: cancer treatment Quaternary: Experimental drug

What two key roles does primary care play in a health care system

gatekeepers and coordinators of care

Outpatient care

person is treated then leave the hospital…does not stay overnight

Inpatient care

Patient stays overnight…they are admitted in the hospital

ambulatory care

Outpatient care

Consolidation 

Hospitals buying up other health practices in the surrounding area

What are some ambulatory care examples you can think of

Minute clinic … emergency department… ambulatory surgery 

How might you describe the consolidation trend in ambulatory care

practices going from solo to group for easier and more time. They also share costs and risks; there is also more than one provider. Hospitals come and buy group practices and surrounding other practices

What are the differences in organizational structures between the following types of ambulatory care settings…Solo, group, and hospital -owned or entity-owned practices

Solo practices: 1 physician working 24/7, managing their own supply, run own practice, highest risk for physician

Group practices: Group of physicians, spread out time, share cost, spread out risk

Entity-owned or hospital-owned practice: Physicians are employees, bottom of the barrel, less risks, loss of status, loss of say and control

Hospital 

6 or more beds…diagnostic and therapeutic services…. license by operating state

Hospital accreditation

Necessary for Medicare and Medicaid reimbursement…conducted by Joint Commission

Joint Commission

Nonprofit organization accredits healthcare organization and programs…. separate from government…aims to improve quality and safety

what are the main hospital classifications/labels

licensing and accreditation

how has the view of hospitals changed from the 1800s to now? how have hospitals involved in the US?

Hospitals were very dangerous throughout the years it has greatly improved. It went from high chance of dying and getting worse to being able to heal and be healthier. Hospitals became more spread out and everyone can almost access it. Due to Err is Human, many people began to lose trust in healthcare systems. 

Tripartite Structure

CEO, board of directors, and CMO all working together to manage and operate the organization

Chief Executive Officer CEO

Head of administrative staff, in charge of hospital, under board of trustees

Chief Medical Officer CMO/ Chief of Staff

Highest level in medical (physician) staff a part of the tripartite structure

Board of Trustees/Board of Directors

group of people respected in the community highest level in hospital hierarchy

Clinical side of the House

physicians and nurses…therapeutic and diagnostic services

Non-clinical side of the House

The people who you do not see and or deal with finding health problem…support, information, administrative services

Hospital admission

a person staying overnight in a hospital

Patient Discharge

A person leaving the hospital

Admitting Physician

Independent from the hospital, but MUST follow medical staff bylaws, and they do NOT answer to the CMO

Attending Physician

Employed by the hospital and they answer to the CMO

Administrative Services

Overall operations of the hospital… Health managers

Informational Services

Anytime information is shared…when walking in and describing problems, document, process information

Therapeutic services

Provides treatment to patients, broken into medical units or documents organized by specialty

Diagnostic Services

Determine the cause of illness and injury through tests and imagery

Support Services

People who keep the hospital environment safe, clean, and functional

What are some example departments/units that make up the therapeutic Services of a hospital?

Oncology unit…Surgical Unit…Pediatric Unit…Women’s Unit…Emergency Department 

What does an attending physician report to?

Chief Medical Officer CMO

What type of professionals works in each of the service areas of a hospital? Which service areas are primary nonclinical? What are primary clinical?

Administrative Services - human resources, health service managers - nonclinical

Informational Services - medical coder - nonclinical

Therapeutic Services - Surgery - clinical

Diagnostic Services - medical imagery person - clinical

Support Services - security - nonclinical

How might a patient interact with each of the service areas of a hospital?

Administrative - scheduling an appointment

information - sharing their medical records

therapeutic - receiving a surgery

Support - receiving Jello after surgery

Long-Term Care

Variety of services for maximum possible independence for people with functional limitations over an extended period of time

Activities of Daily Living

Personal care, bathing, dressing, eating, and using the toilet

Instrumental Activities of Daily Living

everyday tasks, household work, shopping, prepping meals, taking medications

Subacute Care/Post-Acute Care

In the middle of acute care and long-term care…”I’m getting better, but still need some medical help”

what type of patients utilizes long-term care

elderly and disabled people

What are the differences between a Skilled Nursing Facility and a Nursing Facility

Skilled - short term, takes Medicaid, private, long-term insurance, Medicare, has more complex things

Nursing - long-term/indefinity, takes private, Medicaid, long-term insurance, works with less complex stuff

Palliative Care

Any stage of disease…can happen when you don’t think an end is coming…transition from late life to end of life

Hospice Care

Palliative care…physician has to say a patient has less than 6 months to live…not expected to recover…deny curative care treatment

Where might someone receive hospice care

home…hospice center…nursing facility…pallitive care center

What led to the reduction in the number of hospital beds and the rise of multi-unit hospital systems from the 1980s to today?

How robust is the long-term care infrastructure in the US health care system? How ready is it to take on the aging baby boomer population?

How would you explain the differences between hospice and palliative care with respect to location, payment, prognosis, and treatment?

how is long-term care paid for by patients and their families

where might someone go to receive long-term care? What are those different settings?