Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
71 Cards in this Set
- Front
- Back
|
requirements of licensure
|
fingerprinting, application notarization
|
|
|
percentage of uninsured in the US
|
16%
|
|
|
healthcare GDP currently
|
17%
|
|
|
project of GDP for healthcare in 2020
|
20%
|
|
|
the UK and Canada's GDP
|
UK: 8 going to 10
Canada: 12% |
|
|
concerns for purchasers of healthcare
|
the constant escalation of premium costs on an annual basis
health care costs are affecting international competitiveness and profits |
|
|
concerns for payers of healthcare
|
they get revenue on a capitated basis (a set sum of money up front), but expenses are on a per piece basis (based on the number of visits needed); margin comes from controlling expenses
no control over volume of pieces trying to determine how to get "value" |
|
|
concerns for providers
|
multiple payers, multiple rules... but trying to control volume and prices
every sector has significant competition looking for profitable niches: hospitals-->specialty hosptials pharmaceuticals-->generics physicians-->limited scope providers: "off-shoring" liability insurance systems |
|
|
concerns for patients about healthcare
|
shrinking coverage w/ increased premiums, deductibles and copays
at the bottom of the "risk shift" cascade... health care costs are increasing pressure on household budgets |
|
|
major concerns about access
|
high un-insurance rate, increased out of pocket expenses to patients
geography variability in provider distribution - rural and inner city |
|
|
major health care concerns about cost
|
costs in all sectors are increasing
issues of international competitiveness and value received per $ |
|
|
major health care concerns about quality
|
significant variation in quality of processes and outcomes by institution and procedures
demonstrated difficulty in ahcieving system changes to address quality and patient safety issues |
|
|
major health care concerns about equity
|
major differences in US population regarding health status according to race, and socioeconomic status
|
|
|
ACA effect on rising health care costs
|
keeps GDP from growing to 20, maybe stays around 18-8.5%
|
|
|
why did health care reform happen?
|
16/16-->20/20
increasing cost to business.. and public the problems of the uninsured Obama and Democratic Congress |
|
|
why is healthcare reform so hard
|
U.S. Constitution
American culture of "choice" "special interests" attached to 17% of GDP complexity of issue : not just one system-many, easy to pick one target to defeat |
|
|
what is next in healthcare reform
|
complexities of implementation
efforts to "repeal" unanticipated problems unexpected benefits unresolved issues (cost, value, workforce) |
|
|
4 elements necessary for a medical malpractice lawsuit
|
duty, breach, proximate cause, and damage
|
|
|
can EMTALA be used in a medical malpractice case
|
No, it cannot b/c it is federal law
|
|
|
4 alternative ways to settle a lawsuit
|
negotiation, mediation, arbitration, pretrial screening process
|
|
|
2 parts of HIPAA
|
privacy rule and security rule
|
|
|
privacy rule of HIPAA
|
established national standards for ePHI that state that an individual's PHI may not be shared except in those manners stipulated in HIPAA except if someone AUTHORIZES IN WRITING
|
|
|
security rule of HIPAA
|
addresses safeguards that "covered entities" must put into place in order to secure individuals' ePHI
|
|
|
business associate in HIPAA terms
|
person or organization that utilizes PHI and who performs functions or activities on behalf of, or provides certain services to a covered entity
|
|
|
entities that are permitted to receive information under the privacy rule
|
the individual, treatment, payment, and health care operations, if needed for another permitted use, public interest and benefit activities, limited data set for the purposes of research, public health, or health care
|
|
|
T or F Security Rule applies to PHI transmitted orally or in writing
|
F
|
|
|
confidentiality, integrity, and availability under HIPAA's security rule
|
confidentiality: ePHI is not available or disclosed to unauthorized persons
integrity: ePHI is not altered or destroyed in an unauthorized manner availability: ePHI is acccessible and usable on demand from authorized person |
|
|
demands on covered entity from the security rule
|
limit physical access to facilities
implement policies to specify proper use of workstations and electronic media have in place policies regarding transfer, removal, and disposal of electronic media |
|
|
HITECH
|
Health Information Technology for Economic and Clinical Health Act (HITECH)
passed in 09 as part of the American Recovery and Reinvestment Act creates incentives related to health care information technology contains incentives to accelerate adoption of EMR widens scope of HIPAA and adds enforcement: e.g. patients must be notified of a security breach |
|
|
HHS must be notified of a HIPAA breach of
|
500 ppl or more
|
|
|
EMTALA's 3 primary requirements
|
1. hospital must provide "appropriate" medical screening test to anyone who comes to ED
2. if pt has emergency medical condition, hosp. must treat and stabilize pt or transfer pt 3. hosp. must not transfer pt. w/ emergency medical condition that has not been stabilized unless certain conditions are met |
|
|
TPO
|
treatment, payment, and healthcare operations
these incorporate the must routine uses of PHI and do not require permission |
|
|
why is medical school 4 years
|
b/c it takes 4 years to develop responsibility
|
|
|
state medical board hoops
|
fingerprinted
application notarization report if there has ever been a compliant or investigation against you report if you have ever been denied the privilege of taking an exam report if you have used an illegal substance or used a legal one illegally in the past 5 years report if charged w/ a misdemanor--felony |
|
|
4 physician adages
|
look at all x-rays ordered
repeat abnormal laboratory tests take the time to explain what is happening to your patients treat you patients like your parents or children would want to be treated |
|
|
telemedicine
|
someone from outside a state practicing medicine in that state
|
|
|
global burden of disease
|
assessment of the causes of death, disability, and loss of health in different populations: by age, sex, and by geographic region or country income
|
|
|
the reason why there is a risk transition between primarily infectious diseases in developing countries and primarily non-communicable diseases in developed countries
|
1. improvements in medical care which mean that children no longer die from easily curable diseases such as diarrhea
2. aging of the population b/c non-communicable diseases typically happen in the elderly 3. public health interventions such as vaccinations, clean water, and sanitation |
|
|
"attributable" burden of disease
|
burden of disease resulting from exposure to risks
|
|
|
disability-adjusted life years (DALYs)
|
one DALY is one lost year of "healthy year"
gives more weight to non-fatal loss of health and deaths at younger ages |
|
|
leading cause of death in low-income countries
|
pneumonia 1st, then heart disease, diarrhea, HIV/AIDS, and stroke
|
|
|
leading causes of death for high-income countries
|
heart disease, stroke, lung cancer, pneumonia, and asthma/bronchitis
|
|
|
5 leading global risks for mortality
|
high BP, tobacco use, high blood glucose, physical inactivity, being overweight and obese
they affect low, middle, and high income nations alike |
|
|
T or F overweight or obese causes more death than underweight worldwide
|
T
|
|
|
leading cause of death for children under 5 in developing countries and leading risk factor
|
respiratory illness and diarrheal diseases
leading risk factor=being underweight |
|
|
5 leading risk factors cause...
|
25% of deaths in the world
|
|
|
what percentage of global burden or disease occurs in low or middle income countries
|
over 75%
|
|
|
EBM and KT
|
EBM answers a question and assume implementation
KT assumes the evidence and attempts to implement the change |
|
|
research to practice pipeline
|
studies-->systematic reviews-->synposes-->systems to the pipe: aware, accepted applicable, (bedside EBP) able, acted on, agreed to, adhered to (agreed to and adhered to are behavior change strategies)
|
|
|
US spends... on healthcare
|
double versus industrialized nations and are last in preventable death
|
|
|
results of commonwealth fund
|
no improvement between 2006-2008
access to health care significantly declined health system efficiency remained low |
|
|
who procedures clinical practice guidelines
|
NIH
AHRQ Professional Societies Local Health Organizations Individual Depts |
|
|
why use guidelines
|
reduces variation where evidence exists
intervention in areas with substandard outcomes literature more accessible to clinicians (knowledge translation) GUIDELINE ADHERENCE IMPROVES OUTCOMES |
|
|
barriers to KT
|
lack of familiarity/awareness due to volume of info, time needed to stay informed, access to resources
lack of agreement with evidence (uncertain interpretation, unclear applicability...) external barriers (environmental factors, perceived medico-legal concerns |
|
|
how could we get ppl to use guidelines
|
education outreach, electronic reminders, publicly publish scorecards of quality of practice, required reporting of usage, P4P, not pay for poor performance
|
|
|
CPQE
|
Committee for Procedural Quality and Evidence Based Practice (Dr. Wright's website)
|
|
|
two obstacles for KT
|
getting the evidence straight, getting the evidence used
|
|
|
bedside EBM
|
troubling divergence between questions that arise during clinical encounters and readily available pathways to find the answer, can be assisted by the use of mobile devices
|
|
|
what has been demonstrated to be a more powerful motivator than financial incentives
|
purpose and intrinsic motivation
|
|
|
formation or professional character traits
|
1. industrious, 2. balanced, 3. endurance, 4. systematic/methodical 5. observant, 6. memory, 7. punctual and patient 8. benevolent, 9. honest, truthful, 10. humility
|
|
|
Johari Window
|
what is known/unknown to self/other
|
|
|
Flexner
|
professionalism is a dynamic and fundamentally social process, envisioned altruism as important part of profession
|
|
|
"good" doctor traits of the past
|
encylopedic knowledge
independent always available master of rescue care physicians were professional by virtue of their training |
|
|
"good" doctor traits of the present
|
solid fund of knowledge but gatherer of information
team player emotionally intelligent embrace QI and public reporting evidence-based patient-centered altruism: is important but missing |
|
|
nostalgic professionalism
|
reflected in calls for physicians to recommit to traditional medical values, often pitting altruism against commercialism
physicians put the interests of others first physicians respond to societal needs physicians have humanistic values like honest, integrity, caring and compassion, altruism and empathy, respect for others, and trustworthiness principles of primacy of patient, patient autonomy, and social justice |
|
|
professionalism as complexity
|
nostalgic professionalism, entrepenural professionalism, academic professionalism, lifestyle professionalism, empirical professionalism, unreflective professionalism, activist professionalism
|
|
|
micro versus macro
|
currently is micro/macro but should be macro/micro
|
|
|
systems view of professionalism
|
expressed in observable behaviors
behaviors are profoundly influenced by organizational and environmental context not strictly attitudinal competency professionalism is not a static quality that "if strong enough should transcend or withstand the pressure of negative influences" |
|
|
Medical Board of Ohio's Agency Mission
|
to protect and enhance the health and safety of the public through effective medical regulation
|
|
|
a depature from the standard of care whether o tnot actual injury to the pt is established is
|
a minimum standards of care violation
|
|
|
DIARRHEA
|
duty, integrity, altruism, respect, responsibility, honor, excellence, and accountability
|
