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33 Cards in this Set
- Front
- Back
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Primary prevention |
Prevent the disease before it occurs Eg vaccination |
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Secondary prevention |
Screen early and management of disease Eg Pap smears |
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Tertiary prevention |
Treatment to reduce complication of disease that is ongoing or have long term effect Eg chemotherapy surger |
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Quaternary prevention |
Quit Avoid Unnecessary medical intervention |
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Major medical insurance plan |
1- Exclusive provider organization 2- Health maintenance organization 3- Pointe if service 4- Preferred provider organization 5- Accountable care organization |
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Exclusive provider organization |
1- Referral not needed 2- Restricted to a limited panel (ex emergencies) |
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Health maintenance organization |
1- Require referral form 2- Restricted to a limited panel 3- Denial of service is it does not meet an establish evidence based guideline |
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Point of service |
1- Require referral 2- Patient can see providers outside of network 3- Higher co-pay and deductible for out of network services |
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Preferred provider organization |
1- Referral not needed 2- Patients can see providers outside of network 2- higher co-pay and deductible for all services |
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Accountable care organization |
1- Specialists voluntarily enroll 2- Providers voluntarily enroll 3- Medicare |
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What insurance plans require referral from a primary care physician to see a specialist |
Health maintenance organization Point of service |
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Types of healthcare payment models |
1- Bundled payment 2- Capacitation - HMO 3- Discounted fee for service - PPO 4- Fee for serve 5- Gloval payment |
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Capacitation payment model |
1- Physician receives a set amount per patient for a particular period of time 2- Regardless of how much the patient uses the healthcare system |
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Bundle payment |
2- Physician receive a set amount per patient 2- Divided among all providers/facility involved |
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Global payment |
Patient pays for all expenses associated with a single incidence of care with a single payment |
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Fee for service |
Patient pays for individual service |
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Discounted fee for service |
Patient pay for each individual service at a discounted rate |
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Medicare |
1- >65 2- <65 with disability 3- ESRD end stage renal disease |
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Medicaid |
For person with limited income and/or resources |
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4 parts of Medicare |
Part A- Hospital Admission Part B- Basic medical Bills Part C- Combination of A and B-delivered by approved private company Part D- Prescription Drug |
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Hospice care |
1- Providing comfort and palliation instead of a definitive cure 2- Available for Medicare Medicaid and most private insurance plan whose life expectancy <6 month as 3- Principle of double effect- Prioritizing the positive effect over the negative effect |
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In an effort to improve patients comfort/pain during hospice care, what medications are often administered |
Opioids Sedatives Anxiolytics |
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Common cause of death <1 years |
1- Congenital malformation 2- Preterm birth 3- Maternal pregnancy complication |
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Common cause of death in 1-14 years old |
1- Unintentional injury 2- Cancer 3- Congenital malformation |
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Common cause of death 15-34 |
1- Unintentional injury 2- Suicide 3 Homicide |
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Common cause of death 35-44 |
1- Unintentional injury 2- Cancer 3- Heart disease |
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Common cause of death 45-64 |
1- Cancer 2- Heart disease 3- Unintentional injury |
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Common cause of death >65 |
1- Heart disease 2- Cancer 3- Chronic respiratory disease |
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Common cause for transmission Medicare |
1- Congestive HF 2- Septicemia 3- Pneumonia |
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Common cause of readmission Medicaid |
1- Mood disorder 2- Schizophrenia/ psychotic disorder 3- Diabetes Mellitus with complication |
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Common cause of readmission with private insurance |
1- Maintaining chemotherapy and radiation 2- Mood disorder 3- Complication from surgical procedure or medical care |
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Common cause of readmission for no insurance |
1- Mood disorder 2- Alcohol related disorder 3- Diabetes Mellitus with complication |
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6 important components of patient centered interviewing technique |
Introduction Agenda setting Reflection Validation Recapitulation Facilitation |
