Chapter 2 The Health Care Delivery System

Front 1

Who is the biggest consumer of healthcare?

Back 1

The federal government.

Front 2

What are PSRO's? (Professional Standards Review Organizations)

Back 2

Professional Standards Review Organizations. They review the quality, quantity, and cost of hospital care.

Front 3

What are UR committees? (Utilization Review)

Back 3

Medicare-qualified hospitals has physician supervised groups (UR) committees, to review admissions, diagnostic testing, and treatments provided by physician's who cared for clients receiving Medicare.

Front 4

What was the intent of UR's? (Utilization Review)

Back 4

To identify and eliminate the overuse of diagnostic and treatment services.

Front 5

What is the Prospective Payment System?

Back 5

One of the most significant factors that influenced payment for healthcare. It eliminated cost-based reimbursement. Hospitals who were caring for Medicare patients who no longer allowed to charge whatever the clients care cost.

Front 6

What are DRG's? (Diagnosed Related Groups?)

Back 6

Prospective Payment System divided inpatient hospital services for Medicare clients into 48 groups that have a fixed re-imbursement, regardless of the length of client stay or extra labs needed.

Front 7

Define Capitation

Back 7

Most health care providers (health care networks and manager care organizations, AKA INSURANCE COMPANIES) now receive capitated payments. This means insurance companies receive a fixed amount per client or enrollee of a health care plan.

Front 8

Managed Care

Back 8

Insurance Companies. But basically they provide administrative control over primary health care services for a defined population.

Front 9

What is the goal of managed care?

Back 9

To increase access to health care, while decreasing costs.

Front 10

Name some things healthcare providers offer in a variety of different settings.

Back 10

DISEASE PREVENTION
HEALTH PROMOTION
CARE AT THE:
PRIMARY
SECONDARY
TERTIARY
*ALL IN DIFFERENT SETTINGS(

Front 11

What are the health care settings or level's of health care?

Back 11

1. PREVENTATIVE
2. PRIMARY
3. SECONDARY
4. TERTIARY
5. RESTORATIVE
6. CONTINUING CARE

Front 12

Give some examples of Preventive Care

Back 12

Blood pressure and cancer screenings, Immunizations, Poison Control Information, Mental health counseling and crisis prevention, community legislation (seat-belts, air bags)

Front 13

Give some examples of Primary Care (Health Promotion)

Back 13

Prenatal Care, Well-baby care, nutrition counseling, family planning, excercise classes

Front 14

Give some examples of Secondary Acute Care

Back 14

Emergency care, acute-medical surgical care, radiological procedures.

Front 15

Give some examples of Tertiary Care

Back 15

Insentive Care
Subacute Care

Front 16

Give some examples of Restorative Care

Back 16

Cardiovascular and Pulmonary Rehabilitation
Sports Medcine
Spinal cord injury programs
Home Care

Front 17

Give some examples of Continuing Care

Back 17

Assisted Living
Nursing Home

Front 18

What is the difference between "primary care" and "primary health care"?

Back 18

Primary Care focuses on health services provided on an individual basis while Primary Health Care focuses on improved health outcomes for an entire population.

Front 19

What does "work redesign" pertain to?

Back 19

The fact that more services are available on nursing units thus eliminating the need to transfer clients across multiple diagnostic and treatment areas.

Front 20

Describe the case management model of care.

Back 20

A case manager, who is usually a nurse or a social worker, coordinates the efforts of all disciplines to achieve the most efficient and appropriate plan of care for the client. Case management focuses primarily on discharge planning.

Front 21

What is a discharge plan?

Back 21

A discharge plan begins immediately upon patient admittance to the hospital or acute setting. Discharge planning is centralized, and is a multidisciplinary process that ensures the client has a plan for continuing care after leaving the facility.

Front 22

What is a critical pathway plan?

Back 22

A multidisciplinary treatment plan that outlines the treatments or interventions clients need to have while in the hospital for a specific condition or procedure. For example, there are critical pathways for patients with pneumonia, and congestive heart failure.

Front 23

Name some instruction clients typically require prior to leaving the hospital.

Back 23

- Safe and effective use of medications and medical equipment
- Instruction on potential food and drug interactions and counseling on nutrition & modified diets
- Rehab techniques to support adaptation to environment
-Access to community resources
-When and How to obtain further treatment
-The families and the client's responsibilities in the client's ongoing care.

Front 24

Name some examples of places you would receive preventative and primary care.

Back 24

-Schools
-Physician's Offices
-Occupational Health Clinics

Front 25

Name some examples of places you would receive Secondary and Tertiary Care.

Back 25

-Hospitals
-Intensive Care
-Psychiatric Facilities
-Rural Hospitals

Front 26

Name some examples of places you would receive Restorative Care.

Back 26

-Via Home Health Care Agencies
- Rehabilitation (ie; Fairlwan)
- Extended Care Facilities

Front 27

Name some examples of places you would receive Continuing Care.

Back 27

-Nursing Centers or Facilities (nursing homes)
- Assisted Living
-Respite Care
-Adult Day Care Centers
- Hospice

Front 28

Define restorative care.

Back 28

To help individuals regain maximal functional status and to enhance quality of life through promotion of independence and self care.

Front 29

Define home care.

Back 29

The provision of medically related professional and para-professional services and equipment to clients and families in their homes for health maintenance, education, illness prevention, diagnosis, palliation, and rehabilitation.

Front 30

Define rehabilitation.

Back 30

Restores a person to the fullest physical, mental, social, vocational and economic potential possible.

Front 31

Define extended care facility.

Back 31

Provides intermediate medical, nursing, and custodial care for clients recovering from an acute illness or clients with chronic disease or disabilities. Extended care facilities also includes intermediate care/skilled nursing facilities.

Front 32

Define skilled nursing facility.

Back 32

Offers skilled care from a licensed nursing staff. This often included administration of IV fluids, wound care, long-term ventilator care, and physical rehabilitation.

Front 33

Define Assisted Living.

Back 33

Offers an attractive long-term care setting with a homier environment and greater resident autonomy.

Front 34

Define Respite Care.

Back 34

A service that provides short term relief or time off for persons providing home care to an ill family member.

Front 35

Define Adult Day Care Centers.

Back 35

Provide a variety of health and social services to specific client populations who live alone or with family in the community.

Front 36

Define Hospice.

Back 36

A system of family centered care that allows clients to live and remain at home with comfort, independence, and dignity while easing the pains of a terminal illness.

Front 37

What are nursing sensitive outcomes?

Back 37

They are client outcomes that are directly related to nursing care. Examples of these are:
-nosocomial infections
-deep vein thrombosis
-uti's
-pressure ulcers
-falls
-failure to rescue

Front 38

What is client centered care?

Back 38

Dimensions of care that affect a clients experience with health care most.

Front 39

What are the seven dimensions of Client Centered Care, according to Picker Commonwealth Program for Client Centered Care.

Back 39

1. Respect Values, Preferences, and Expressed Needs
2. Coordination and Integration of Care
3. Information, Communication, and Education
4. Physical Comfort
5. Emotional Support and Relief of Fear and Anxiety
6. Involvement of Family and Friends
7. Transition and Continuity

Front 40

Define nursing informatics.

Back 40

This is the process of combining the best computer science and information science with nursing science.

Front 41

Who are considered vulnerable populations as a result of urbanization?

Back 41

Children, women, and older adults.