Please enter something

Nursing Concept II Chapter 8 Healthcare Delivery Systems PowerPoint Notes

question

IOM’s Six Outcomes for a New Health System for the 21st Century
answer

1. Safe 2. Effective 3.Efficient 4.Patient-centered 5.Timely 6.Equitable
question

Safe Care
answer

avoiding injuries to patients
question

Effective Care
answer

providing cared based in scientific knowledge
question

Patient-centered care
answer

Providing respectful and responsive care that ensure that patients values guide clinical decisions
question

Timely care
answer

reducing waits for both recipients and provides of care
question

Efficient care
answer

avoiding waste
question

Equitable care
answer

ensuring that the quality of care does not vary because characteristics such as gender, ethnicity, socioeconomic status, or geographic location
question

Health Care: The Big Picture Issues
answer

1. Access to healthcare 2. Quality and safety 3. Affordability
question

Characteristics of a Continuously Learning Health Care System
answer

1. Science and informatics 2.Patient-clinician partnerships 3.Incentives 4. Continuous learning culture
question

Science and informatics
answer

real time access to knowledge, digital capture of the care experience
question

Patient-clinician partnerships
answer

engaged,empowered patients
question

Incentives
answer

aligned for value; full transparency
question

Continuous learning culture
answer

leadership-instilled culture of learning, supportive system competencies
question

IOM’s 4-Tiered Strategy to Prevent Medical Errors
answer

1. Establish 2. Identify and learning 3. Raising 4. Implementing
question

Establishing
answer

a national focus to create leadership research, tools, and protocols to enhance our knowledge about safety
question

Identifying and learning
answer

from errors be developing a nationwide public mandatory reporting system
question

Raising
answer

performance standards and expectations for improvements in safety through the actions of oversight organizations, professional groups, and group purchasers of health care
question

Implementing
answer

safety systems in health care organization to ensure safe practices “just culture”
question

Strategies to Promote Quality of Care
answer

1. Pay per performance (CMS reimbursement based on customer satisfaction scores and patient outcome) 2. Penalties for excess readmission
question

Patient Protection and Affordable Care Act Goals (PPACA)
answer

1. Expand coverage, control health care costs, and improve the health care deliver system 2.Provide Medicaid or subsidized coverage to qualifying people with incomes up to 400% of poverty, beginning in 2014 3. Provide a new way to get health insurance: the Health Insurance Marketplace
question

The Health Insurance Marketplace
answer

Designed to help people more easily find health insurance that fits their budget
question

Frameworks for Healthcare Delivery
answer

1. Managed care systems 2. Case management (Milliman, InterQual) 3. Primary healthcare
question

Managed care system
answer

HMO (Health Maintenance Organization),PPOs (Preferred Provider Organization)
question

Case Management
answer

1. Transparency of Evidence 2. Confidence in Decision Making 3. Bringing Payors and providers together
question

Primary healthcare
answer

essential healthcare accessible to all
question

Managed care systems
answer

provide care that controls the cost while maintaining the quality of care
question

Case management is
answer

a method of managed care in which nurses often identify protocols and timetables for care
question

Primary healthcare is
answer

essential healthcare accessible to communities at a cost that is affordable
question

Federally funded healthcare programs
answer

Medicare and Medicaid
question

Managed Care Systems
answer

1. Controls cost of care while maintaining quality of care 2. Manager or ‘gatekeeper” plans and monitors the care 3. Limits the choice of care providers 4. Requires approval for specialty care
question

Case Management
answer

1. Coordinates 2. Controls costs 3. Improves access to healthcare 4. Uses critical pathway to identify protocols and timetables for care
question

Coordinates care
answer

role of nurse is coordinator of care
question

Uses critical pathways to identify protocols and timetables for care
answer

1. Evidence-based treatments for complex cases 2. Problem-oriented general recovery
question

Evidence-based treatments for complex cases
answer

identify treatments based on the best evidence concerning comorbidities and complex symptoms or disgnoses
question

Problem-oriented general recovery
answer

detailed clinical indication for admission when a patient has multiple illnesses, multiple traumas, or other systemic problems
question

Case Managers’ Role
answer

1.Advocacy and Education 2.Clinical Care Coordination/Facilitation 3.Continuity/Transition Management 4.Utilization/Financial Management 5.Performance & Outcome Management 6.Psychosocial Management 7/ Research and Practice Development
question

Advocacy and Education
answer

ensuring the patient has an advocate for needed service and any needed education
question

Clinical Care Coordination/Facilitation
answer

coordinating multiple aspects of care to ensure the patient progresses
question

Continuity/Transition Management
answer

transitioning of the patient to the appropriate level of care needed
question

Utilization/Financial Management
answer

managing resource utilization and reimbursement for serivices
question

Performance and Outcome Management
answer

monitoring and if needed intervening to achieve desired goals and outcomes for both the patient and the hospital
question

Psychosocial Management
answer

assessing and addressing psychosocial needs including individual, familial, environmental, etc.
question

Research and Practice Development
answer

identifying practice improvements and using evidence based data to influence needed practice changes
question

Primary Healthcare
answer

1.Essential healthcare based on acceptable methods and technology 2.Universally accessible and affordable to individuals and families on the community 3.Brings healthcare close to where people live and work
question

Healthcare Settings
answer

1.Hospitals 2.Primary care centers 3.Ambulatory care centers and clinics 4.Home healthcare 5.Long-term care facilities 6.Specialized care centers and settings 7.Healthcare services for caregivers and end-of-life care 8.Healthcare agencies
question

Hospital Settings
answer

1.Provide inpatient and outpatient care 2.Vary in size and services 3.Classified as profit or nonprofit,public or private 4.Employ more nurses than any other facility
question

Roles of Nurses in Hospitals
answer

1.Direct care providers 2.Manager of other members of healthcare team 3.Administrator 4.Nurse practitioner 5.Clinical nurse specialist 6.Patient educator 7.In-service educator 8.Researcher
question

Roles of Nurse in Primary Care Centers
answer

1.Make health assessments 2. Perform technical procedures 3.Assist the physician 4. Provide health education
question

Roles of Nurse in Ambulatory Care Centers
answer

1. Provide technical services 2.Determine the priority of care needs 3.Provide teaching about all aspect of care
question

Long-term care Facilities
answer

1. Transitional subacute care 2.Intermediate and long-term care 3.Nursing home 4.Retirement centers 5.Residential institutions for mentally physically disabled 6.”Aging in place”
question

Specialized Care Centers
answer

1. Daycare centers 2.Mental health centers 3.Rural health centers 4.Schools 5.Industry 6.Homeless shelters 7.Rehabilitation centers
question

Hospice
answer

provides physical,psychological, social, and spiritual care for dying persons
question

Respite care
answer

is provided for caregivers of homebound ill, disabled, or elderly patients
question

Parish nursing
answer

emphasize holistic care, health promotion, and disease prevention activities
question

Voluntary agencies
answer

are community agencies that are often nonprofit and provide a setting for support groups
question

Home Healthcare
answer

1.Most rapidly growing area of the healthcare system 2.Driven by payment system of reimbursement-early discharge from hospitals 3.Serves increasing number of older people with chronic illnesses 4.Provides for a dignified death at home
question

Caregiver and End-of-life Care
answer

1.Respite care 2.Hospice care 3.Bereavement care 4.Palliative care
question

Healthcare Agencies
answer

1.Voluntary agencies 2.Parish nursing 3.Government agenicies 4.Veterans administration and military agencies 5.Public health service 6.Public health agencies
question

Members of the Healthcare Team
answer

1.Physician, physician assistant 2.Physical, respiratory, occupational, and speech therapist 3.Dietitian 4.Pharmacist 5.Social worker 6.Unlicensed assistive personnel
question

Role of the Physician
answer

1.Diagnosis of illness 2.Medical or surgical treatment of illness **prescribing medications** **interpreting results of lab and diagnostic tests** **performing procedures and surgery**
question

Payment funded programs
answer

1.Federally funded programs 2.Group plans 3.Private insurance 4.Long-term care insurance
question

Federally funded programs
answer

1.Medicare-DRGs 2.Medicaid
question

Group plans
answer

1. Health maintenance organizations 2. Perferred provider organizations
question

HMOs
answer

are provided group[managed care providers that subscribe to receive care through affiliated providers
question

Preferred provider
answer

organization allow members to choose an outside physician for an additional cost
question

Private insurance
answer

allow members to choose their own physicians
question

Federally funded healthcare programs
answer

use a prospective payment plan based on diagnosis-related groups
question

Healthcare Issues
answer

1.Focus on preventive care 2.Knowledgeable consumers 3.Cost containment 4.Fragmentation of care 5.Healthcare -a right or a privilege?
question

Goals of Healthcare Reform
answer

1. Cost containment 2.Improved access to care 3.Increased quality of services for all
question

Nurse’s Role in Healthcare Reform
answer

1.Stay informed about current issues and legislation 2. Write members of congress to support legislation to improve nursing care 3.Belong to nursing organization 4.Document the outcomes of nursing care 5.Be a leader in nursing and consumer groups 6.Advocate for the right of all to healthcare
question

Strategies to Reduce Health Care Costs/Reimbursements and Regulations
answer

1.DRGs and RUGs prospective payment system 2.Capitation and manged care 3.Bundle payments 4.Rate setting 5.Comparative effectiveness analysis 6.Increasing patient cost sharing
question

Strategies to Reduce Health Care Costs/Changes in Care Delivery
answer

1.Utilizing quality improvement tools to reduce waste and improve safety 2.Improving transitions across settings 3.Making the delivery of medical services more efficient and less costly 4.Eliminating unnecessary costs such as fraud and abuse 5.Improving population health