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213 Cards in this Set
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- Back
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Differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist among specific population groups in the US |
health disparities |
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more likely to experience poorer health outcomes, decreased life expectancy, higher mortality, and premature deaths + less likely to be recipients of health care services geared toward health promotion, disease prevention, and early detection of disease - suffer disproportionate burden of disease |
health disparities: racial/ethnic minorities, disabilities, women, economically/educationally disadvantaged, medically underserved
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examples of racial/ethnic minorities associated with health disparities
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African Americans, Hispanic Americans, Asian Americans/Pacific Islanders, American Indians, Alaska Natives |
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reasons for health disparities appear to be: |
multifactorial, poorly understood, complex |
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among minorities, correlates strongly with health disparities |
race, ethnicity |
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key factors of disparities: |
- insurance status - socioeconomic status - residential/geographic segregation - ESL - Cultural/racial bias - patient/provider relationship |
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In January 2010, the US Senate passed legislation that seeks to address health care disparities through programs that would benefit most Americans |
Patient Protection and Affordable Care Act |
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thought to be the primary impact of the ACA |
general provisions aimed at reducing financial barriers to care, thereby increasing access to care and providing access to health insurance for an additional 32 million Americans who are not eligible for a group insurance plan |
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strong evidence that indicates a correlation to health disparities |
low health literacy |
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degree to which individuals can obtain, process, and understand basic health information as well as the capacity to which an individual can ascertain services prerequisite to make appropriate health decisions |
health literacy |
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ethnic/racial disparities summary |
infant mortality - cancer screening - CV Disease - Diabetes - HIV/AIDS - immunizations |
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outcomes of minorities |
- experience poorer health outcomes - decreased life expectancy - higher mortality - premature death
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minorities less likely to: |
- be recipients of health promotion services - disease prevention - early detection - access of high quality medical treatment |
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low literacy skills often correlate with: |
- decreased health awareness and knowledge - inferior self-management skills - increased hospitalization - inadequate physical and mental health - increased healthcare costs - increase in mortality rate
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issue with low health literacy |
"most information is not presented in user-friendly format"
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percent of english speaking americans who have adept health literacy skills |
12% |
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cannot comprehend how to use common health information |
9 out of 10 |
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health initiative set forth for health promotion and disease prevention-objectives for the nation |
healthy people 2020 |
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defined disparities as referring to more than race/ethnicity--all play pivotal role in receipt of health care |
- gender - sexual identity - age - disability - socioeconomic status - geographic location - language - education - disability |
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seeks to address disparities by additional government programs and program goals |
- Affordable Care Act - Reduce financial barriers to come - increasing access to care - provide access to health insurance for an additional 32 million americans (who were not eligible for a plan) |
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Professional roles of the PA concerning disparities
"few other issues of such magnitude can be so effectively addressed by one PA-one patient at a time" |
- become knowledgeable about disproportionate burden of disease that exists in US among minority populations - efforts to improve quality of health care - improvement in health literacy
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broad definition of health care delivery systems |
major components and processes of the systems that enable people to receive healthcare |
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narrow definition of health care delivery systems |
the act of providing health care to patients (ie. hospital, clinic) |
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primary objectives of a health care system |
1. to enable all citizens to receive health care services 2. to deliver services that are cost-effective 3. meet established standards of quality |
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functional components of health care delivery |
1. financing 2. insurance 3. delivery 4. payment |
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to buy or to pay for health care services consumed-usually employer based |
function component of health care delivery: financing |
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- to protect against catastrophic events - to determine which package the individual is eligible to receive |
function component of health care delivery: insurance |
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any entity that delivers health care services and receives insurance payment directly for those services |
provider (functional component of health care delivery) |
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the determination of how much to pay for a service |
payment (functional component of health care delivery) |
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payment in health care delivery |
- funds come from premiums paid to insurance company - patient usually pays co-pay, and the insurance company pays remainder |
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coordinated continuum of services to a large population of patients in a cost efficient manner |
integrated systems |
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Introduced to decrease hospital costs by identifying standard lengths of stay for designated conditions and putting hospitals at financial risks for longer hospitalizations |
diagnostic related groups (DRG) |
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designed to restrict uncontrolled growth in hospital beds and new technologies |
certificate of need laws |
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private practice, group practice |
horizontally integrated systems |
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shared ownership |
vertically integrated systems |
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contractual relationships |
virtually integrated systems |
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consolidating under one organizational roof and common ownership all levels of care, from primary to tertiary |
vertically integrated |
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identify PAs as a solution to physician shortage |
ACA of 2010 |
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provide a decrease of cost to LTC |
Home health options |
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"home" can = in home health |
individual home, congregate housing, assisted living (ALF), inpatient hospice, skilled nursing facility (SNF), or LTC facility |
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home visits are reimbursable from Medicare: true or false? |
true |
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aspects of hospice |
- palliative care - home, inpatient, assisted living, nursing home - pharmacy aspects: pain management, respiratory management - physical assessment - psychosocial - interdisciplinary care: nurse, medical director, social workers, clergy, volunteers |
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usually funded via private payment from residents |
ALFs |
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growth in ALFs will most likely require: |
that medical providers will be providing more care in ALFs |
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long term = |
>6 months and chronic care of co-morbiditity |
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short term = |
following acute hospitalization |
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aspects of nursing home care: rates? |
low reimbursement rates
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aspects of nursing home care: increase in...
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growing increase in acuity of the patients
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aspects of nursing home care: PAs in this area |
very few in this area |
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aspects of nursing home care: patient rounding |
- patients must be seen every 30 days for first 3 months and then at 30 to 60 day intervals after |
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aspects of nursing home care: PA's scope concerning admission/initial move to LTC |
- PA's cannot do the initial comprehensive visit-must be completed by MD |
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reaffirms the McKinney Act definition of a homeless person |
HEARTH act |
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HEARTH act stands for |
Homeless Emergency Assistance and Rapid Transition to Housing |
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definition of homeless according to HEARTH act and McKinney act: |
1. individual who lacks a fixed, regular, and adequate nighttime residence 2. individual who has a primary nighttime residence that is a/an: supervised shelter, institution for temporary residence, public/private place not designated for regular sleeping accommodations 3. families who have unstable housing and individuals who will face homelessness in next 14 days
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main groups of homeless patients |
- chronically mentally ill - chronically on streets and do not usually use shelters - chronic alcoholics and substance abuse - situationally distressed
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makes up large majority of chronic alcoholic and substance abuse homeless population |
male >45yo |
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major contributor to problem of homelessness |
chronic alcohol and substance abuse |
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situationally distressed = |
single persons or families with loss of income, traveling for job |
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approx 40% of all those living in severe poverty are: |
children |
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make up 37% of homeless |
families |
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22% of homeless |
younger than 18yo |
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homeless rates for men are ____ than for women |
lower - 27% men - 32% women |
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large population of veterans are: |
homeless |
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how does a clinician know if a patient is homeless? |
body habitus, lack of family support, connection, untreated medical problems, social history |
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using military corpsmen to respond to the needs in our health care system |
"American Concept" |
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historical ancestors |
feldshers (Russia) barefoot doctors (China)
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Used to occupy physician shortage in Europe of 17th/18th centuries - went on to cover need in rural areas
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Feldshers |
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two year program and 90% woman including midwives |
feldsher |
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has a more complimentary approach rather than substitutional |
Physician-feldsher team |
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originated in the 1965 Cultural Revolution as a substitution for the physician |
China Barefoot Doctor |
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Barefoot doctors in China were encouraged to ... |
go onto medical school |
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barefoot doctors in China had (considerable / little) supervision |
considerable |
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Have greatly declined in last years due to physician |
Feldshers (Russia) Barefoot Doctors (China) |
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Beginning in 1930's, former military corpsmen received on |
Federal Prison System |
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Was later discontinued and consisted of a 4 month program during WWII by US Coast Guard |
Coast guard trained purser mates to provide health care on merchant ships |
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Both above served as predecessors to later federally trained PA programs |
- military corpsmen (Federal Prison System) - Coast guard training program for purser mates on merchant ships |
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Dr. Charles Hudson introduced the need for an assistant to |
1961 |
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Informally trained extension of physicians Dr. Amos Johnson and Mr. Buddy Treadwell (role models for the |
1960s |
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In 1965 Dr. Henry Silver and Mrs. Loretta Ford, RN created a... |
practitioner-training program for nurses to work with impoverished pediatric population |
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Practitioner training program for nurses to work with impoverished pediatric population became the foundation for and in relation to other institutions? |
both the NP movement and the Child - nontransferable to other institutions |
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Late 1950s-1960s: Duke University (Dr. Eugene Stead) created an extension program for nurses which was opposed by the ______________. Subsequently, they began training with: |
- National League of Nursing - firemen, ex-corpsmen and other non-college |
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conditions that fostered PA concept: social consciousness |
social consciousness to eliminate deprivation among societal groups |
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conditions that fostered PA concept: physicians |
- work load concerns - geographical distribution - supply |
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conditions that fostered PA concept: costs and opinions |
- rising health care costs - criticism of system - increasing positive value attached to health |
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conditions that fostered PA concept: physician extender models |
awareness of physician extender models in other countries and in nursing |
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conditions that fostered PA concept: professionals available to fill the role |
ex-corpsman and nurses |
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October 1965: 4 ex-Navy corpsmen entered the 2 year program with a philosophy to: |
provide students with an education and orientation similar to physicians whom they would work |
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Original plans for two categories of: ___________ & __________ merged into one generalized program |
-specialty inpatient care & general practice -life-long learning |
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First time that the_________was being shared with another profession and now it would also be used in ____ |
- privileged physician knowledge - educating the NPs |
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Unique partnership of |
independence through dependence |
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Excepted by the medical model more easily due to the: |
comfortable dependency |
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- most PAs initially chose: - increases raise concerns about future direction of profession |
primary care - specialty positions |
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(just info card) Based on 2013 AAPA Annual Survey for Tennessee: 31.8% Primary Care 27.3% Surgical Subspecialties 15.7% Emergency Medicine 5.6% Internal Medicine 2.5% Pediatrics |
48.6% Solo or group practice 34.3% Hospital hire 3.5% Certified rural health clinic 1.0% Community health center |
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developed by Dr. Richard Smith, a model program to partner with underserved areas and employ PAs for training with plans for employment |
MEDEX model |
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Development of the MEDEX model initial students were: |
military corpsmen |
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term MEDEX came from |
"medical extension" in order to avoid negative connotations associated with "assistant" and conflict over the appropriate use of the word "associate" |
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First postgraduate degree in PA education
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Dr. Silver's "Child Health Associate Program" |
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for those without previous medical experience or military background and with two years of previous college education - bachelors awarded at end of 2nd year - masters awarded at end of training |
Dr. Silver's "Child Health Associate Program" |
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Greek word: " along with" "related to medicine or a physician" |
syniatrist |
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examples of names for PAs during initial development |
- associate - assistant - Medical Extension - Midlevel provider |
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1970 AMA attempted to put an end to the controversy and Congress voted on ______ hoping to decrease the confusion of terms between medical assistant and physician assistant but House of Delegates rejected the term due to the |
"Associate" "held for the use of physician partners" |
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31 new PA programs were established U.S. Public Health Service provided funding to 40 programs |
1971-1973 |
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programs in US currently |
180 |
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trends are toward |
interdisciplinary teams |
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- now with a way to make added |
over extended physicians |
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AAPA= |
American Academy of Physician Assistants |
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TAPA= |
Tennessee Academy of Physician Assistants |
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APAP= |
Association of Physician Assistant Programs |
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PAEA= |
Physician Assistant Education Association |
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--- several countries were becoming |
By the mid-1990s |
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Individual PAs and well as PA programs began working with the government and institutions to: |
transfer the profession overseas |
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has grown to a population of more |
Dutch PA profession |
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number of Dutch schools |
Approximately 5 training schools |
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Dutch program set up |
Didactic and clinical training days interspersed through training |
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Not Making significant advances with the inclusion of prescriptive practice nor the ability of PAs to perform technical procedures |
false |
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At the forefront of the efforts to standardize the PA role across the European Union (NAPA) |
Netherlands |
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- Started in 1992 and now have approximately 7 programs - Focus on training surgical PAs - Programs range in length from 2 to 4 years |
India |
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Follow an American-style PA curriculum but they have adapted it to fit their specific medical needs
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India |
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Almost no PAs work in primary care, almost all specialize |
India |
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Currently are three 3- year baccalaureate programs in science PA in Germany since 2012 Graduates will work under the capacity allowed under the current law |
The first program was launched in 2010 |
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The first program was launched in 2010 |
saudi arabia |
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Follow a traditional American-style PA model curriculum Eventual deployment across all divisions of the military Expected to be the first of several programs Known as assistant physicians (APs) due to a translation issue |
Saudi Arabia |
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One of the most under resourced health systems in the world - PA course was launched in October 2010 |
Afghanistan |
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- 12-month didactic period with a month-long pharmacology course - 16-week clinical phase with "sick call" and emergency medicine/trauma - Expectations are that PAs will be ready to face challenges of providing medical care in a war zone - Female students of the program will not be part of active combat units but will work in district military hospitals |
Afghanistan |
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- Known as clinical associates (CAs)
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south africa |
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- The Twinning Project - Follow a 3 year curriculum - First cohorts graduated in 2011 |
South African Clinical Associate Schools were "twinned" with American PA schools |
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- Began in 2008 - PA model was developed in the military as an advanced medical technician (medical assistant) during the Korean War and transitioned to the present PA concept |
Canada |
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Each providence in Canada allows for: |
a particular degree of delegation and supervisory requirement |
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- Struggles with a shortage of doctors, more so in rural,indigenous, and public health sectors - First PA program in 2009 |
Australia |
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Australian PA program facts: |
- PA curriculum is delivered in a blended format, combining six intensive (2-week) blocks over the first 24 months interspersed with distance learning - the third year is = clinical training - Designed for mature health care professional with extensive clinical experience |
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Average age of Australia student in a PA program |
41 -designed for mature health care professional with extensive experience |
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UK's first program |
2004 |
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UK programs/PAs originally expected to work in ______ however the demand had grown for _____ and _____
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- primary care - work in hospitals and specialty practices |
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goal of safety in the clinical setting |
to prepare students for clinical sites |
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can occur at clinical site |
minimal supervision |
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all PA programs require....when they are admitted |
basic health information |
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the only information allowed to be disclosed to programs: |
- immunizations - results of TB screening |
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most, if not all programs require students to have this vaccine before starting |
Hep B |
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basic requirements of PA students regarding their basic health upon enrollment are required by: |
ARC-PA for accreditation of the program |
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Students may receive info on: |
- HIPAA (Health Insurance Portability and Accountability Act - sexual harassment |
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required before the clinical year |
second physical exam |
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Three things to keep in mind on rotations pertaining to safety |
- be aware of surrounding and particular risks in that environment - know if chaperones are needed for male or female patients - know what to do if you sustain and injury and always have your protocol with you |
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- Control guidelines in place to protect health care professions for exposure - Implemented in 1980’s as a way to treat all patients are potential risks of HIV, Hepatitis B transmitters - use of PPE
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Universale Precautions |
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Use of personal protective equipment includes: |
masks, eye protection, gowns, gloves |
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Examples from table 10-1: universal precautions required |
- semen - vaginal secretions - synovial fluid - CSF - Pleural fluid - Peritoneal fluid - pericardial fluid - amniotic fluid |
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examples from 10-1 of things that do not require Universal Precautions |
- feces - nasal secretions - sputum - sweat - tears - urine - vomitus (unless contaminated with blood) - saliva (unless contaminated with blood |
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For international travel, check theses: |
- health care insurance coverage for treatment and evacuation policy - malpractice coverage - Protect yourself against additional potential concerns of the area |
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are the most effective method of transmitting bloodborne pathogens |
needlesticks |
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Over 350,000______ and _____ occur annually in the US |
needlesticks and other sharps-related |
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One PA program reported 22% had exposure and 60% of them were ______ |
percutaneous injuries |
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PA students must take advantage of their__________ and ___________ |
- programs’ training opportunities - Know the policy for reporting any exposure to the program and participating in all follow-up necessary |
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There is a high incidence of failure to report sharps injuries among: - due to: |
- professionals - fear of losing employment, concerns about post exposure prophylaxis, tendency to deny personal risk, |
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Any student who is exposed to blood or body fluids should alert _________ |
their supervising physician immediately. |
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exposure to blood or body fluids may include: |
needle sticks, splashing of fluid into the eyes, or contact of fluids with an open wound on the student's body |
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- Follow the guidelines of: - The student may be advised to receive medication that may _____ |
- the medical center where the exposure occurs. - reduce the risk of contracting a disease. |
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- Following an exposure and immediately alerting your supervising physician, students should complete ___________ - send where? - for what? - notify: - When? |
- an Exposure Incident Report - Director of Clinical Education for follow-up Notify the clinical staff as soon as possible after initial treatment |
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___________ will be filed with the individual's own insurance |
Medical care and treatments |
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Students are required to be screened for tuberculosis: |
annually |
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criteria for TB positivity, by risk group: reaction greater than or equal to 5mm of induration |
- HIV + persons
- recent contacts of TB+ patients - Fibrotic changes on chest radiographs consistent with prior TB - Patients with organ transplants and other immunosuppressed patients [15mg/day prednisone or equivalent[ |
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criteria for TB positivity, by risk group: reaction of greater than or equal to 10mm of induration |
- recent immigrants (w/in past 5 years) from high prevalence countries - IV drug users - residents and employees of high risk congregate settings (prisons, LTC facilities, hospitals, HC facilities, residencies for patients with HIV, homeless shelters, etc...) - mycobacterial lab personnel - at high risk clinically: silicosis, DM, CRF, some hematological d/o, specific malignancies (carcinoma of head/neck/lung) - weight loss greater than or = to 10% - gastrectomy - jejunal bypass |
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criteria for TB positivity, by risk group: reaction of greater than or equal to 15 mm of induration |
persons with no risk factors for TB |
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Increased in the 1980s and 1990s when gloves were recommended as protection against blood borne pathogenS |
Latex allergies |
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Latex protein can be ____ |
aerosolized with removal of gloves |
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latex allergy reactions can be: |
local (skin) , respiratory, or both |
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what must we do about latex allergies? |
YOU MUST REPORT and take precautions |
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For several years, _____ mistreatment has been studied |
medical student |
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on recently has data be collected concerning the treatment of: |
PA Students |
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Results of Asprey survey of a group of PA students |
- 79% of students admitted to having experienced at least one form of mistreatment during their training
- Responsible for the mistreatment were physicians (33%) and PA program faculty (17.7%) |
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survey of mistreatment was consistent with: |
medical students |
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regarding sexual harassment: |
- federal laws protect each person from institution - institution will support in any situation - no tolerance policy
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electronic methods used to manage people’s health care |
Health information technology (HIT) |
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required by legislation to be used to share information across different healthcare services |
Electronic Health Record (EHR) |
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electronic version of the paper chart |
Electronic Medical Record (EMR) |
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virtual chart; additional information including appointments, insurance information, Rx refills, patient education |
Personal Health Record (PHR) |
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The Institute of Medicine report (2000) indicates 44,000-98,000 patient deaths per year due to: |
error |
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provided grants, loans, and assistance |
The Health Information Technology Economic & Clinical Health Act (HITECH) |
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applied “meaningful use” incentives for annual reimbursement options - examples |
- American Reinvestment and Recovery Act (ARRA)
- Requirements such as transmitting prescriptions to the pharmacy electronically, capability to exchange key information with other EHRs |
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by 2015 _____ will apply by Medicaid or Medicare annually to equal up to 1%/year |
penalties |
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discipline at the intersection of information science, computer science, and health care |
Health informatics |
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ARRA focused on: |
- standards - quality needs - functionality - communication - government program links to enhance financial incentives
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exist for the implementation of EHR |
various EHR market vendors |
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30% of implementations fail due to: |
a steep learning curves and loss of productivity |
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When implementing EHR, it is essential to be: |
organized, have patience, and have an attitude of commitment to the end result |
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implementation of EHR involves a plan for: |
"Go Live" date |
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EHR systems involve: |
helpful templates and prompts to assist in charting, organization, and a reduction in error |
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Benefits of EHR: |
- Decrease in medical errors - Legible handwriting - Improvement in clinical decision making- How? - Integration of information - Billing efficiency - Templates are utilized |
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Barriers of EHR |
- Cost - Implementing - Time management for learning the system and maintenance - Poor technical skills
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related to security of information and EHR |
The Health Insurance Portability and Accountability Act (HIPAA) |
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To aid in security of information and care: |
- Control of the system is a must - Assign passwords to monitor - If a breach occurs, immediately inform the patient - “At all times the interest of the patient must be supported” |
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security focus with EHR |
Focus is on unauthorized access to patient data or improper disclosure of health information |
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________ have been estimated to result in total costs of between $17-29 billion annually |
Preventable medical errors |
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How to better deal with errors and why they occur: |
- Change the culture of blaming individuals for errors to viewing errors as opportunities for improvement
- Acknowledge that humans are imperfect
- Try to find ways to anticipate, prevent, or catch events before they cause harm |
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Swiss cheese model of organizational accidents by psychologist ______ Errors are _______ |
- James Reason -results of many layers of fail-safes in which the holes align to yield error |
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The majority of medical mistakes (are/are not) made due to a lack of knowledge or training |
are not |
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Medical professionals must combine: |
complex decision-making skills with customer interaction behaviors |
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considered a component of quality health |
safety |
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types of medical errors: |
- "never events" (National Quality Forum's Heath Care term)
- "sentinel events" (JCAHO) |
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“unexpected occurrences[s] involving death or serious physical or psychological injury, or the risk thereof” |
Sentinel events |
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* Signal the need for immediate investigation
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- Sentinel event--Serious injury
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Top 10 Reported Sentinel Events ('95-'10) |
1. Unintended retention of foreign body 2. Delay in treatment 3. Wrong patient, site, procedure 4. Operative/postoperative complication 5. Suicide 6. Patient fall 7. Medical error 8. Perinatal death or injury 9. Criminal event 10. Other unanticipated event |
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medication errors: common errors include: |
illegible prescriptions and orders |
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making an impact on medication errors involved with illegible prescriptions and orders |
EMR systems |
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Two ways efforts are being made to reduce medication errors |
1. removing or limiting the number of drugs that look or sound alike 2. avoid abbreviations when ordering medications (do not use list) |
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The Joint Commission developed a universal protocol for preventing |
wrong site, procedure, and person surgery |
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Estimated that 1500 cases of _____occur annually |
retained surgical objects |
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Strategies to prevent surgical errors include: |
manual counting, intraoperative/postoperative radiographs, bar coding sponges, electronic article surveillance tags, and radiofrequency identification tags |
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up to 80% of serious medical errors resulted from: |
miscommunication between providers during transitions of care |
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attempts to reduce serious medical errors due to miscommunication |
- standardized approach to handing off patients - communication using SBAR |
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SBAR = |
Situation, background, assessment, recommendation |
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- In 2002, the Joint Commission indicated that patients should: - patients should do these things to be involved: |
- become active in their own health care to help prevent medical errors - speak up about questions or concerns - educate themselves about the illness and medications - use a trusted health care organization - ask a family member or friend to be your advocate |
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Since July 2001, the Joint Commission has required disclosure of: |
adverse outcomes |
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The Sorry Works! Coalition promotes: |
apologies and full disclosures through honesty |
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medical error disclosure results in: |
fewer medical malpractice lawsuits and reduced legal costs |
