Nursing Fundamentals - Unit 3 - HEALTH CARE DELIVERY SYSTEMS

amprevel's version from 2016-03-10 08:00

Section 1

Question Answer
accountable care organizations (ACOs)payment and care delivery model that ties provider reimbursement to quality metrics and reduction in total cost of care for an assigned population of patients.
coinsuranceinsurance plan in which client pays percentage of payment and some other group (e.g. employer or government) pays rest of payment.
critical pathwaysmultidisciplinary guidelines for client care based on specific medical diagnoses designed to achieve specific outcomes
diagnosis-related groups (DRGs)Medicare payment systems to hospitals and physicians that establishes fees according to diagnosis
health care systemtotality of services offered by all health disciplines.
health maintenance organization (HMO)group health care agency, provides basic and supplemental health maintenance and treatment services to voluntary enrollees.
independent practice associations (IPAs)provide care in offices; clients pay fixed prospective payment and IPA pays provider; earnings or losses assumed by IPA.
integrated delivery system (IDS)network of health care organizations under a parent holding company; incorporates acute care, home health, extended and skilled care facilities, and outpatient services.
licensed practical nurse (LPN), and licensed vocational nurse (LVN)practical nurses. Practice under the supervison of an R.N. Provide basic direct technical care to clients.
managed caremethod of organizational care delivery that emphasizes communication and coordination of care among all health care team members.
MedicaidU.S. federal public assistance program paid out of general taxes, admininastered through states. Proved healthcare to those who require financial assistance.
Medicarenational and state health insurance program. US citizens ≥65y.
preferred provider arrangements (PPAs)can be contracted with individual health care providers, plan can be limited or unlimited.
preferred provider organization (PPO)group of physicians or hospital that provides companies with health services at a discounted rate
safety-net hospitalshospitals that provide significant level of care to low-income, uninsured and vulnerable populations.
Supplemental Security Income (SSI) benefitsspecial payments for people with disabilities, blind, not eligible for Social Security; payments not restricted to healthcare costs

Section 2

Question Answer
Describe the purpose of various types of health care services, agencies, and providers.Hospitals provide a wide variety of services on an inpatient and outpatient basis. Hospitals can be categorized as public or private, for-profit or not-for-profit, and acute care or long-term care. Many other settings, such as clinics, offices, and day care centers, also provide care. Various providers of health care coordinate their skills to assist a client. Their mutual goal is to restore a client’s health and promote wellness
What is goal of primary care services?health promotion and illness prevention.
What is goal of secondary care services?diagnosis and treatment.
What is goal of tertiary care services?rehabilitation, health restoration, and palliative care.
Compare various systems of financing for health care serviceshealth care is financed largely through government agencies and private organizations that provide health care insurance, prepaid plans, and federally funded programs. Government-financed plans include Medicare and Medicaid. Private plans include Blue Cross and Blue Shield. Prepaid group plans include HMOs, ACOs, PPOs, PPAs, IPAs, and PHOs.

Section 3

Question Answer
functional nursing care delivery frameworkfocuses on jobs to be completed. Task-oriented approach. Personnel with les preparation perform less complex care requirements. Based on production and efficiency model. Economical, efficient. Fragmented care. Non-quantifiable aspects such as emotional needs may be overlooked.
team nursing care delivery frameworkdelivery of nursing care to clients by a team led by a professional nurse.
primary nursing care delivery frameworkone nurse responsible for total care of a number of patients 24 hours a day, 7 days a week; may not personally provide all care; comprehensive, individualized, consistent. Role not compatible for part-time nurses.
case method nursing care delivery frameworktotal care. Earliest nursing models. Client centered method. One nurse assigned to and responsible for comprehensive care of a group of clients during an 8-12 hr shift
differentiated practice nursing care delivery frameworksystem in which the best possible use of nursing personnel is based on education preparation and resulting skill sets (ADN vs BSN).
case management nursing care delivery frameworkmultidisciplinary teams that assume collaborative responsibility for planning, assessing, needs and coordination, implementation and evaluation of care for groups of clients from preadmission to discharge or expert recuperation.
Community-based nursingcare of individual in a geographic local setting. Extends beyond institutional boundaries.

Section 4

Question Answer
Identify challenges facing the health care system and nursing in today’s health care environment.-public disillusionment -uninsured/underinsured -public loss of control over hc decisions -changes in practice settings -ethical issues -health care needs of vulnerable pops -rising costs
Describe individual mandate of ACA Individuals will be fined if they do not have health insurance
What are employers required to do under ACA?must offer insurance coverage if they meet specific requirements
How was Medicaid affected by ACA?significantly expanded
What organizations were created under ACA through which individual and small businesses can purchase insurance?State-based American Health Benefit Exchanges and Small Business Health Options Program (SHOP) Exchanges were created. They are administered by a governmental agency or nonprofit organization.
ACA expanded/extended coverage for what groups?Extended coverage for children and individuals with preexisting health problems.
Organization established by ACA to identify research priorities and conduct research that compares the clinical effectiveness of medical treatmentsPatient-Centered Outcomes Research Institute. nonprofit.
Organization established by ACA to coordinate federal prevention, wellness, and public health activities.National Prevention, Health Promotion, and Public Health Council.



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