The Health Care Delivery System

The health care delivery system Comprehensive understanding 1. Give examples of each of the levels of health care services available in the U.S. health care system. a. Primary care (health promotion): Prenatal care, Family planning, Diagnosis and treatment of common illnesses, Patient-centered medical home b. Preventive care: Immunizations, Diet Counseling, HIV screening for adults at higher risk, A c. Secondary acute care: Urgent care; hospital emergency care d. Tertiary care: intensive care, inpatient psychiatric facilities e. Restorative care: Rehabilitation, Home care f. Continuing care: Assisted living, nursing centers,and older-adult day care 2. Levels of prevention describe the focus of health care–related activities, identify the three levels: a. Health Promotion and Disease Prevention (Primary Prevention) b. Curing of Disease (Secondary Prevention) c. Reducing Complications (Tertiary Prevention) 3. Explain what an integrated health care delivery system (IHCD) is A network of organizations that provides coordinated continuum of services to a population 4. Identify the core mission of hospitals across the country: Delivering the right care, at the right time, and in the right setting 5. Explain the focus of the following two acute care facilities: a. Intensive care units Hospital unit in where patients receive close monitoring and intensive medical care. b. Mental health facilities Where patients with mental illness can receive interprofessional treatment plan that grabs the attention of patients and their families. 6. To improve care for patients residing in rural areas, rural hospitals are expected to: a. Improve access to services b. Encourage rural communities to develop their rural health care systems. c. Develop coordinated delivery systems in the rural community d. By creating protocols for coordinating care transition e. Make sure to be subject matter experts and coordinators for the health care environment 7. Define what discharge planning is. A coordinated process that develops a plan for continuing care after a patient leaves a health care environment 8. What is the focus of discharge planning? Ensures that the patient is able to transition to a setting in which their health care needs are met 9. Describe the following models of discharge planning that focus on the patient and their family caregiver: a. Care transitions program It emphasizes the role of a transition coach which manages the discharge of a patient to a rehabilitation center .b. Transitional care model Emphasizes inclusive discharge planning and follow-ups for older adults c. High-intensity care-team Helps patients manage their health conditions, manage their health care, and achieve their overall health 10. Identify the discharge instructions that are required by the Joint Commission (TJC): a. Discharge medications b. Follow-up care c. List of all medications changed d. Dietary needs e. Follow-up tests or procedures. 11. List the tips on making a referral process. a. Engage the patient and family caregiver in the referral process b. Make the referral as soon as possible. c. Give the provider getting the referral as much information as needed d. The provider will make the recommendations needed. 12. The goal of restorative care is: It helps individuals regain full functional status and to achieves a maximum quality of life by promoting independence and self-care 13. What is the focus of home health care? Helping patients and their family members gain independence. 14. __________Rehabilitation_________ is a process aimed at enabling people with disabilities to reach and maintain their optimal physical, sensory, intellectual, psychological and social functional levels. Match the following. 15. _____b._______ Extended care facility 16. _____c.______ Continuing care a. 24-hour intermediate and custodial care b. Includes immediate care and skilled nursing facilities 17. _____a._______ Nursing center c. Services are for people who are disabled, not functionally independent, or who suffer a terminal disease 18. _____d._______ Assisted living d. Long-term care setting with an environment like home and greater resident autonomy 19. _____e._______ Respite care e. Provides short-term relief to the family members who care for the patient f. Provides a variety of health 20. _____f.______ Adult day-care center and social services to specific patients populations who live in the community 21. _____g._______ Hospice g. Is a system of familycentered care that allows patients to live with comfort, independence, and dignity while easing the pains of a terminal illness Issues in health care delivery Match the following health care payment models: 22. ____b._______ Fee-for-service a. Includes both the gain share potential of an upside model, 23. ____e._______ Pay-forcoordination 24. ____c._______ Pay-forperformance (P4P) 25. ____g._______ Episode-of-care payment 26. ____d.______ Upside sharedsavings program 27. ____a._______ Downside shared-savings programs 28. ____f._______ Partial or full capitation but also the downside risk of sharing the excess costs of health care delivery between provider and payer b. Most traditional health care payment model; requires patients or payers to reimburse the provider for each service performed c. Value-based reimbursement; providers are compensated only if they meet certain metrics for quality and efficiency d. Provide incentives for providers treating specific patient populations; % of net savings go to providers e. Coordinates care between the primary care provider and specialists f. Payments are assigned a permember per-month (PMPM) payment g. Reimburses health care providers for specific episodes of care; a set amount of money will be paid 29. Identify the payment system that the Social Security Act established under Medicare A: _Inpatient Prospective Payment System otherwise known as the IPPS. 30. Factors that have been identified to improve patient satisfaction are: a. Communication techniques b. Hourly rounding c. Nurse staffing patterns d. Bedside report 31. Identify the two main reasons for a nursing shortage. a. The baby boomers age b. The need for health care growing 32. Identify the Quality and Safety Education for Nurses competencies for Registered Nurses: a. Patient-Centered Care b. Teamwork and Collaboration c. Evidence-Based Practice (EBP) d. Quality Improvement (QI) e. Safety f. Informatics 33. The Institute of Medicine defines patient-centered care as: Care that is respectful of and responsive to individual patient preferences, needs, and values 34. Identify the eight principles of patient-centered care: a. Respecting the patients’ values, preferences, and expressed needs b. Coordination and integration of care c. Information and education d. Physical comfort e. Emotional support and alleviation of fear and anxiety f. Engagement of family and friends g. Continuity and transition h. Access to care 35. Health care organizations that apply for Magnet status must demonstrate: a. Quality patient care b. Nursing excellence c. Change in professional practice 36. The revised Magnet model has five components affected by global issues; please identify them. a. Transformational Leadership b. Structural Empowerment c. Exemplary Professional Practice d. New Knowledge, Innovation, and Improvements e. Empirical Quality Results 37. Explain nurse-sensitive outcomes and give some examples. Patient outcomes and nursing workforce characteristics that are related to nursing care 38. Explain telemedicine. Technology that depends on interactive video; uses medical information that is gathered and reviewed on site and sent to another site to improve people’s health 39. Health care disparities are: Differences in health care results and dimensions of health care 40. Identify the social determinants of health that are linked to health care disparities: a. Availability of resources to meet needs b. Access to education, economic, and job opportunities c. Access to health care services d. Quality of the education and job training e. Availability of community-based resources that support the community f. Transportation options g. Public safety h. Social support i. Social norms and attitudes j. Exposure to crime, violence, and social disorders k. Socioeconomic conditions l. Residential segregation m. Language and literacy n. Access to mass media and new technologies o. Culture Case study 41. A school nurse has been following a 9-year-old student who has behavioral problems in class. The student acts out and does not follow teacher instructions. The nurse plans to meet with the student’s family and learn more about social determinants of health that might be affecting them. What specific factors would you consider in this assessment? The type of support parents offer when the student completes their homework, the level of violence in the family, and the cultural values about education that are held by the family Review questions Select the appropriate answer and cite the rationale for choosing that particular answer. 42. Health promotion programs are designed to help patients: 1. Reduce the incidence of disease 2. Maintain maximal function 3. Reduce the need to use more expensive health care services 4. All of the above Answer: All of the above Rationale: _All of the health promotion programs help to reduce the incidence of disease, minimize complications, reduce needing to use more expensive health care resources. __ 43. Rehabilitation services begin: 1. When the patient enters the health care system 2. After the patient’s physical condition stabilizes 3. After the patient requests rehabilitation services 4. When the patient is discharged from the hospital Answer: When the patient enters the health care system Rationale: _Rehabilitation begins once the patient has entered the system and then helps maximize the patient’s level of independence. 44. An example of an extended care facility is a: 1. Home care agency 2. Skilled nursing facility 3. Suicide prevention center 4. State-owned psychiatric hospital Answer: Skilled nursing facility Rationale: _It is where they will receive supportive care until they are able to move back into the community. 45. A patient and his or her family facing the end stages of a terminal illness might best be served by a: 1. Hospice 2. Rehabilitation center 3. Extended care facility 4. Crisis intervention center Answer: Hospice Rationale: __The focus is on palliative care and not curative treatment.