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41 Cards in this Set

  • Front
  • Back
Who is the biggest consumer of healthcare?
The federal government.
What are PSRO's? (Professional Standards Review Organizations)
Professional Standards Review Organizations. They review the quality, quantity, and cost of hospital care.
What are UR committees? (Utilization Review)
Medicare-qualified hospitals has physician supervised groups (UR) committees, to review admissions, diagnostic testing, and treatments provided by physician's who cared for clients receiving Medicare.
What was the intent of UR's? (Utilization Review)
To identify and eliminate the overuse of diagnostic and treatment services.
What is the Prospective Payment System?
One of the most significant factors that influenced payment for healthcare. It eliminated cost-based reimbursement. Hospitals who were caring for Medicare patients who no longer allowed to charge whatever the clients care cost.
What are DRG's? (Diagnosed Related Groups?)
Prospective Payment System divided inpatient hospital services for Medicare clients into 48 groups that have a fixed re-imbursement, regardless of the length of client stay or extra labs needed.
Define Capitation
Most health care providers (health care networks and manager care organizations, AKA INSURANCE COMPANIES) now receive capitated payments. This means insurance companies receive a fixed amount per client or enrollee of a health care plan.
Managed Care
Insurance Companies. But basically they provide administrative control over primary health care services for a defined population.
What is the goal of managed care?
To increase access to health care, while decreasing costs.
Name some things healthcare providers offer in a variety of different settings.
What are the health care settings or level's of health care?
Give some examples of Preventive Care
Blood pressure and cancer screenings, Immunizations, Poison Control Information, Mental health counseling and crisis prevention, community legislation (seat-belts, air bags)
Give some examples of Primary Care (Health Promotion)
Prenatal Care, Well-baby care, nutrition counseling, family planning, excercise classes
Give some examples of Secondary Acute Care
Emergency care, acute-medical surgical care, radiological procedures.
Give some examples of Tertiary Care
Insentive Care
Subacute Care
Give some examples of Restorative Care
Cardiovascular and Pulmonary Rehabilitation
Sports Medcine
Spinal cord injury programs
Home Care
Give some examples of Continuing Care
Assisted Living
Nursing Home
What is the difference between "primary care" and "primary health care"?
Primary Care focuses on health services provided on an individual basis while Primary Health Care focuses on improved health outcomes for an entire population.
What does "work redesign" pertain to?
The fact that more services are available on nursing units thus eliminating the need to transfer clients across multiple diagnostic and treatment areas.
Describe the case management model of care.
A case manager, who is usually a nurse or a social worker, coordinates the efforts of all disciplines to achieve the most efficient and appropriate plan of care for the client. Case management focuses primarily on discharge planning.
What is a discharge plan?
A discharge plan begins immediately upon patient admittance to the hospital or acute setting. Discharge planning is centralized, and is a multidisciplinary process that ensures the client has a plan for continuing care after leaving the facility.
What is a critical pathway plan?
A multidisciplinary treatment plan that outlines the treatments or interventions clients need to have while in the hospital for a specific condition or procedure. For example, there are critical pathways for patients with pneumonia, and congestive heart failure.
Name some instruction clients typically require prior to leaving the hospital.
- Safe and effective use of medications and medical equipment
- Instruction on potential food and drug interactions and counseling on nutrition & modified diets
- Rehab techniques to support adaptation to environment
-Access to community resources
-When and How to obtain further treatment
-The families and the client's responsibilities in the client's ongoing care.
Name some examples of places you would receive preventative and primary care.
-Physician's Offices
-Occupational Health Clinics
Name some examples of places you would receive Secondary and Tertiary Care.
-Intensive Care
-Psychiatric Facilities
-Rural Hospitals
Name some examples of places you would receive Restorative Care.
-Via Home Health Care Agencies
- Rehabilitation (ie; Fairlwan)
- Extended Care Facilities
Name some examples of places you would receive Continuing Care.
-Nursing Centers or Facilities (nursing homes)
- Assisted Living
-Respite Care
-Adult Day Care Centers
- Hospice
Define restorative care.
To help individuals regain maximal functional status and to enhance quality of life through promotion of independence and self care.
Define home care.
The provision of medically related professional and para-professional services and equipment to clients and families in their homes for health maintenance, education, illness prevention, diagnosis, palliation, and rehabilitation.
Define rehabilitation.
Restores a person to the fullest physical, mental, social, vocational and economic potential possible.
Define extended care facility.
Provides intermediate medical, nursing, and custodial care for clients recovering from an acute illness or clients with chronic disease or disabilities. Extended care facilities also includes intermediate care/skilled nursing facilities.
Define skilled nursing facility.
Offers skilled care from a licensed nursing staff. This often included administration of IV fluids, wound care, long-term ventilator care, and physical rehabilitation.
Define Assisted Living.
Offers an attractive long-term care setting with a homier environment and greater resident autonomy.
Define Respite Care.
A service that provides short term relief or time off for persons providing home care to an ill family member.
Define Adult Day Care Centers.
Provide a variety of health and social services to specific client populations who live alone or with family in the community.
Define Hospice.
A system of family centered care that allows clients to live and remain at home with comfort, independence, and dignity while easing the pains of a terminal illness.
What are nursing sensitive outcomes?
They are client outcomes that are directly related to nursing care. Examples of these are:
-nosocomial infections
-deep vein thrombosis
-pressure ulcers
-failure to rescue
What is client centered care?
Dimensions of care that affect a clients experience with health care most.
What are the seven dimensions of Client Centered Care, according to Picker Commonwealth Program for Client Centered Care.
1. Respect Values, Preferences, and Expressed Needs
2. Coordination and Integration of Care
3. Information, Communication, and Education
4. Physical Comfort
5. Emotional Support and Relief of Fear and Anxiety
6. Involvement of Family and Friends
7. Transition and Continuity
Define nursing informatics.
This is the process of combining the best computer science and information science with nursing science.
Who are considered vulnerable populations as a result of urbanization?
Children, women, and older adults.