Potter And Perry Chaper 2

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PHYSICIAN-SUPERVISED COMMITTEES TO REVIEW ADMISSIONS, DIAGNOSTIC TESTING, AND TREATMENTS PROVIDED BY PHYSICIANS OR HEALTH CARE PROVIDERS TO PATIENTS

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UTILIZATION REVIEW (UR) COMMITTEE

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PAYMENT MECHANISM FOR REIMBURSING HOSPITALS FOR INPATIENT HEALTH CARE SERVICES IN WHICH PREDETERMINED RATE IS SET FOR TREATMENT OF SPECIFIC ILLNESSES

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PROSPECTIVE PAYMENT SYSTEM (PPS)

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GROUP OF PATIENTS CLASSIFIED TO ESTABLISH A MECHANISM FOR HEALTH CARE REIMBURSEMENT BASED ON LENGTH OF STAY; CLASSIFICATION IS BASED ON THE FOLLOWING VARIABLES: PRIMARY AND SECONDAY DIAGNOSIS, COMORBIDITIES, PRIMARY AND SECONDARY PROCEDURES, AND AGE

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DIAGNOSTIC-RELATED GROUPS (DRG'S)

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PAYMENT MECHANISM IN WHICH A PROVIDER RECEIVES A FIXED AMOUNT OF PAYMENT PER ENROLLEE

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CAPITATION

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METHOD OF CLASSIFICATION FOR HEALTH CARE REIMBURSEMENT FOR LONG-TERM CARE FACILITIES

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RESOURCE UTILIZATION GROUPS (RUG'S)

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HEALTH CARE SYSTEM IN WHICH THERE IS ADMINISTRATIVE CONTROL OVER PRIMARY HEALTH CARE SERVICES. REDUNDANT FACILITIES AND SERVICES ARE ELIMINATED, AND COSTS ARE REDUCED. PREVENTATIVE CARE AND HEALTH EDUCATION ARE EMPHASIZED

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MANAGED CARE

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SET OF PROVIDERS AND SERVICES ORGANIZED TO DELIVERY A COORDINATED CONTINUUM OF CARE TO THE POPULATION OF PATIENTS SERVED AT A CAPITAL COST

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INTEGRATED DELIVERY NETWORKS (IDN'S)

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PATTERN OF HEALTH CARE IN WHICH A PATIENT IS TREATED FOR AN ACUTE EPISODE OF ILLNESSM FOR THE SEQUELAE OF AN ACCIDENT OR OTHER TRAUMA, OR DURING RECOVERY FROM SURGERY

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ACUTE CARE

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HEALTH CARE SETTING AND SERVICES WHERE PATIENTS WHO ARE RECOVERING FROM ILLNESS OR DISABILITY RECEIVE REHABILITATION AND SUPPORTIVE CARE

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RESTORATIVE CARE

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MANAGED CARE ORGANIZATION THAT CONTRACTS WITH PHYSICIANS OR HEALTH CARE PROVIDES WHO USUALLY ARE MEMBERS OF GROUPS AND WHOSE PRACTICES INCLUDE FEE-FOR-SERVICE AND CAPITATED PATIENTS

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INDEPENDANT PRACTIVE ASSOCIATIONS (IPA'S)

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FORMAL PROCESS USED TO ANALYZE THE WORK OF A CERTAIN WORK GROUP AND TO CHANGE THE ACTUAL STRUCTURE OF THE JOBS PERFORMED

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WORK REDESIGN

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ORGANIZED SYSTEM FOR DELIVERING HEALTH CARE TO AN INDIVIDUAL PATIENT OR GROUP OF PATIENTS ACROSS AN EPISODE OF ILLNESS AND/OR A CONTINUUM OR CARE; INCLUSED ASSESSMENT AND DEVELOPMENT OF A PLAN OF CARE, CORDINATION OF ALL SERVICES, REFERRAL, AND FOLLOW-UP;USUALLY ASSIGNED TO ONE PROFESSIONAL

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CASE MANAGEMENT

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ACTIVITIES DIRECTED TOWARD IDENTIFYING FUTURE PROPOSED THERAPY AND THE NEED FOR ADDITIONAL RESOURCES BEFORE AND AFTER RETURNING HOME

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DISCHARGE PLANNING

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TOOLS USED IN MANAGE CARE THAT INCORPORATE THE TREATMENT INTERVENTION OF CAREGIVERS FROM ALL DISCIPLINES WHO NORMALLY CARE FOR A PATIENT

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CRITICAL PATHWAY

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LEVEL OF MEDICAL SPECIALTY CARE PROVIDED TO PATIENTS WHO NEED A GREATER INTENSITY OF CARE THAN THAT PROVIDED IN A SKILLED NURSING FACILITY BUT WHO DO NOT REQUIRE ACUTE CARE

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SUBACUTE CARE

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PATIENTS WITH EXTENDED LENGTHS OF STAY BEYOND ALLOWABLE INPATIENT DAYS OR COSTS

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OUTLIERS

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HEALTH SERVICE PROVIDED IN THE PATIENT'S PLACE OF RESIDENCE FOR THE PURPOSE OF PROMOTING, MAINTAINING, OR RESTORING HEALTH OR MINIMIZING THE EFFECTS OF ILLNESS AND DISABILITY

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HOME CARE

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FEDERALLY FUNDED NATIONAL HEALTH INSURANCE PROGRAM IN THE U.S FOR PEOPLE OVER THE AGE OF 65. THE PROGRAM IS ADMINISTERED IN TWO PARTS. PART A PROVIDES BASIC PROTECTION AGAINST COSTS OF MEDICAL, SURGICAL, AND PSYCHIATRIC HOSPITAL CARE. PART B IS A VOLUNTARY MEDICAL INSURANCE PROGRAM FINANCED IN PART FROM FEDERAL FUNDS AND IN PARY FROM PRIMIUMS CONTRIBUTED BY PEOPLE ENROLLED IN THE PROGRAM

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MEDICARE

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STATE MEDICAL ASSISTANCE TO PEOPLE WITH LOW INCOMES, BASED ON TITLE XIX OF THE SOCIAL SECURITY ACT. STATES RECEIVE MATCHING FEDERAL FUNDS TO PROVIDE MEDICAL CARE AND SERVICES TO PEOPLE MEETING CATEGORICAL AND INCOME REQUIREMENTS

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MEDICAID

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RESTORATION OF AN INDIVIDUAL TO NORMAL OR NEAR-NORMAL FUNCTION AFTER A PHYSICAL OR MENTAL ILLNESS, INJURY, OR CHEMICAL ADDICTION

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REHABILITATION

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AN INSTITUTION DEVOTED TO PROVIDING MEDICAL, NURSING, OR CUSTODIAL CARE FOR AN INDIVIDUAL OVER A PROLONGED PERIOD, SUCH AS DURING THE COURSE OF CHRONIC DISEASE OR DURING THE REHABILITATION PHASE AFTER AN ACUTE ILLNESS

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EXTENDED CARE FACILITY

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INSTITUTION OR PART OF AN INSTITUTION THAT MEETS CRITERIA FOR ACCREDITATION ESTABLISHED BY THE SECTIONS OF THE SOCIAL SECURITY ACT THAT DETERMINE THE BASIS FOR MEDICAID AND MEDICARE REIMBURSEMENT FOR SKILLED NURSING CARE, INCLUDING REHABILITATION AND VARIOUS MEDICAL AND NURSING PROCEDURES

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SKILLED NURSING FACILITY

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REQUIRED BY THE OMNIBUS BUDGET RECONCILIATION ACT OF 1987; THE MDS SERVES AS THE FRAMEWORK FOR ANY STATE-SPECIFIED ASSESSMENT INSTRUMENTS USED TO DEVELOP A WRITTEN AND COMPREHENSIVE PLAN OF CARE FOR NEWLY ADMITTED RESIDENTS OF NURSING FACILITIES

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MINIMUM DATA SET (MDS)

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RESIDENTIAL LIVING FACILITIES IN WHICH EACH RESIDENT HAS HIS OR HER OWN ROOM AND SHARES DINING AND SOCIAL ACTIVITY AREAS

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ASSISTED LIVING

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SHORT-TERM HEALTH SERVICES TO DEPENDANT OLDER ADULTS EITHER IN THEIR HOME OR IN AN INSTITUTIONAL SETTING

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RESPITE CARE

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SYSTEM OF FAMILY CENTERED CARE DESIGNED TO HELP TERMINALLY ILL PERSONS TO BE COMFORTABLE AND MAINTAIN A SATISFACTORY LIFESTYLE THROUGHOUT THE TERMINAL PHASE OF THEIR ILLNESS

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HOSPICE

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KNOWLEDGE THAT IS DERIVED FROM THE INTEGRATION OF BEST RESEARCH, CLINICAL EXPERTISE, AND PATIENT VALUES

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EVIDENCE-BASED PRACTICE

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OUTCOMES THAT ARE WITHIN THE SCOPE OF NURSING PRACTICE; CONSEQUENCES OF EFFECTS OF NURSING INTERVENTIONS THAT RESULT IN CHANGES IN THE PATIENTS SYMPTOMS, FUNCTIONAL STATUS, SAFETY, PSYCHOLOGICAL DISTRESS, OR COSTS

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NURSING-SENSITIVE OUTCOMES

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WORLDWIDE SCOPE OR APPLICATION

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GLOBALIZATION

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INDIVIDUALS WHO ARE MORE LIKELY TO DEVELOP HEALTH PROBLEMS AS A RESULT OF EXCESS RISKS, LIMITS IN ACCESS TO HEALTH CARE SERVICES, OR BEING DEPENDENT ON OTHERS FOR CARE

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VULNERABLE POPULATIONS