Vocab From Ch2 Fundamentals Of Nursing

Front 1

Who is the biggest purchaser of health care?

Back 1

P16 Federal Govt re: Medicare and Medicaid

Front 2

Professional Standards review organizations (PSROs)

Back 2

p16 to review the quality, quantity, and cost of hospital care

Front 3

Utilization Review Committees (UR)

Back 3

p16 Medicare-qualified hospitals had physician-supervised _____to review the admissions, diagnostic testing, and treatments provided by physicians who cared for clients receiving Medicare. Intent of URs was to identify and eliminate overuse of diagnostic and treatment services many hospitals added nursing case managers to meet the guidelines established by Medicare, Medicaid, and other payers.

Front 4

Prospective Payment System

Back 4

p16 One of the most significant factors that influenced payment for health care was the _____. Established by Congress in 1983, the PPS eliminated cost=based reimbursement. Hosptials serving clients who received Medicare benefits were no longer able to charge whatever the client's care cost. Used DRGs

Front 5

Diagnosis-Related groups (DRGs)

Back 5

p16 PPS grouped inpatient hospital services for Meicare clients into 468 _______. Ea. group had a fixed reimbursement amount w/ adjustments based on case severity, rural/urban/regional costs, and teaching costs.

Front 6

DRG part 2

Back 6

p16 Hospitals receive a set dollar amount for ea. client based on assigned DRG, regardless of client's length of stay or use of service in the hospital.

Front 7

Capitation

Back 7

p16 Most health care providers (networks or MCO) now receive capitated payments. ____mean the providers received a fixed amount per client or enrollee of a health care plan. The aim of __is to build a payment plan for select diagnoses or surgical procedures that consists of the best standards of care, including essential diagnostic and treatment procedures at the lowest cost.

Front 8

Resource Utilization Groups

Back 8

p16 Health care providers now use DRGs in the rehabilitation setting, and ___ in long-term care.

Front 9

Managed Care

Back 9

p17 Health care systems in wh. there is administrative control over primary health care services for a defined client population. ___ goal is to keep people healthy, reducing medical costs.

Front 10

Health Care Settings

Back 10

p17 Preventive, Primary, secondary, tertiary, restorative, and continuing care settings

Front 11

DRG part 2

Back 11

p16 Hospitals receive a set dollar amount for ea. client based on assigned DRG, regardless of client's length of stay or use of service in the hospital.

Front 12

Capitation

Back 12

p16 Most health care providers (networks or MCO) now receive capitated payments. ____mean the providers received a fixed amount per client or enrollee of a health care plan. The aim of __is to build a payment plan for select diagnoses or surgical procedures that consists of the best standards of care, including essential diagnostic and treatment procedures at the lowest cost.

Front 13

Resource Utilization Groups

Back 13

p16 Health care providers now use DRGs in the rehabilitation setting, and ___ in long-term care.

Front 14

Managed Care

Back 14

p17 Health care systems in wh. there is administrative control over primary health care services for a defined client population. ___ goal is to keep people healthy, reducing medical costs.

Front 15

Health Care Settings

Back 15

p17 Preventive, Primary, secondary, tertiary, restorative, and continuing care settings

Front 16

Integrated Delivery Networks (IDN)

Back 16

p17 Larger health care systems have developed ___that include a set of providers and services organized to deliver a continuum of care to a poulation of clients at a capitated cost in a particular setting. Reduces duplication of service across levels.

Front 17

Disease Prevention

Back 17

Activities that protect people from becoming ill because of actual or potential health threats

Front 18

Health Promotion

Back 18

Activities that develop human attitudes and behaviors to maintain or enhance well-being

Front 19

MCO (Managed Care Organizations)

Back 19

Organizations that provide or contracts for sp. health care services (e.g., hospital care, prescription medications)

Front 20

Primary Care

Back 20

Provision of integrated, accessible health care services by health care professionals who address a majority of personal health care needs, develop partnerships w/ clients, and care for families and communities (individual basis)

Front 21

Primary Health Care

Back 21

Combination of primary and public health care that is accessible to individuals and families in a community and provided AT AN AFFORDABLE COST (for an entire population)

Front 22

Public Health:

Back 22

Community and interdisciplinary care aimed at preventing disease and promoting health

Front 23

primary prevention

Back 23

health-promoting behaviors or activities that reduce the occurrence of an illness

Front 24

secondary prevention

Back 24

early diagnosis and treatment of illness (e.g., screening for hypertension)

Front 25

tertiary prevention

Back 25

Care that prevents FURTHER progression of disease

Front 26

Preventive Care

Back 26

more disease oriented and focused on reducing and controlling risk factors for disease through activities such as immunization and occupational health programs.

Front 27

Work Design

Back 27

Many hospitals have redesigned nursing units with __. More services are available on nursing units, minimizing need to transfer and transport clients to diff. areas.

Front 28

Case management

Back 28

p21 either a nurse or social worker is a case manager, containing costs by coordinating efforts of all disciplines to achieve most efficient and appropriate plan of care for the client. Coordinates Referrals, continues after client is discharged.

Front 29

Discharge Planning

Back 29

p21 Discharge planning begins the moment a client is admitted to a health care facility.___is a centralized, coordinated, multidisciplinary process that ensures that the client has a plan for continuing care after leaving a health care agency

Front 30

Critical Pathway

Back 30

p21 tool nurses use in an acute care setting to coordinate client care. Multidisciplinary treatment plan that outlines the treatments or interventions clients need to have while in the hospital for a sp. condition or procedure.

Front 31

Restorative Care Settings

Back 31

p23 Clients receive intravenous fluids, enteral nutrition, pain control in a home or rehabilitation setting.

Front 32

Restorative Care

Back 32

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

Front 33

Rehabilitation

Back 33

p23 restores a person to the fullest physical, mental, social, vocational, and economic potential possible. After a physical or mental illness, injury, or chemical addiction

Front 34

respite care

Back 34

p24 short term relief for persons providing home are to an ill, disabled, or frail older adult

Front 35

1998 Pew Health Professions Commission

Back 35

p26 recommended 21 competencies for health care prof. Emphasizes importance of public service, caring for the health of communities, and developing ethically responsible behaviors.

Front 36

Evidenced Based Practices

Back 36

problem solving approach to clinical practice that involves the conscientious use of current best evidence, along with clinical expertise and client preferences and values in making decisions about client care. Goal - effective client care.

Front 37

Health Plan Employer Data and Information Set (HEDIS)

Back 37

p27 (quality measure) collects various data to measure the quality of care and services provided by different health plans. Health plans rely on ___. ___compares how well health plans perform in 3 key areas,: quality of care, access to care, and client satisfaction w/ the health plan and doctors.

Front 38

Centers for Medicaid and Medicare Services (CMS)

Back 38

Uses HEDIS and created QI for health care facilities as well as health care providers.

Front 39

Quality Improvement (QI)

Back 39

p27 focuses on improving the performance of all providers. Providers receive outcome feedback and make corrections accordingly.

Front 40

Joint Commission Requires . . .

Back 40

p27 health care organizations to determine how well an organization meets client needs and expectations.

Front 41

Nursing Sensitive Outcomes

Back 41

are client outcomes that are directly related to nursing care. NURSING OUTCOMES CLASSIFICATION - to help nurses better define and measure the impact of their interventions.

Front 42

Ex of Nursing sensitive outcomes

Back 42

p27 incidence of pressure ulcers hospital acquired pneumonia, deep vein thrombosis, UTI, 30 day mortality. (higher levels of staffing, fewer negative client outcomes)

Front 43

7 dimensions of client-centered care

Back 43

SEE p. 28 Covers most of the scope of nursing practice

Front 44

Nursing informatics

Back 44

p29 Combines the best of computer science and information science with nursing science. Helps manage and process nursing data (ie blood pressure), information (organize, structure or interpret data) and knowledge (when nurses combine and identify relationships btwn pieces of info).

Front 45

vulnerable populations

Back 45

women, children, and older adults most threatened by urbanization p30