healthcare consumer
culturally diverse, unhealty lifestyle habits, chronic illnesses. Living in an urban
environment, potential for poverty, exposed to environmental stressors
health
state of well-being in all dimensions, not just absence of disease.
illness
response of a person to disease in which a person's level of functioning has changed
cultural diversity
by 2042, over half of US population will belong to a group other than white, non-
Hispanics.
aging population
by 2020, 21.8 million people in US will be over 75 due to baby boomer generation.
unhealthy lifestyles
determined by obesity, tobacco, stress, sedentary lifestyles, substance abuse, chronic
illness, urbanization
deterioration of environment
depletion of resources, pollution, environmental crisis (oil spills)
violence against nurses
increase in violence has led to a majority of nurses having experienced violence by
patients and fellow nurses who are psychological distress from the profession
de-escalation techniques
techniques that all nurses are required to be trained in due to the rise in violence. Used
to be only for mental health nurses.
ANA Position Statement on violence
upholds that all nursing personnel have right to work in healthy work environments free
of abusive behavioral such as bullying, hostility, lateral abuse and violence, sexual
harassment, intimidation, abuse of authority and position, and reprisal for speaking out
against abuses
managed care
organized, high-quality, cost-effective system of healthcare that influences the selection
and use of healthcare services of a population.
capitation
system of payment for each customer served, rather than by service performed. Gives
providers a fixed amount per enrollee of health plan. Aims to build a payment plan for
select diagnoses or procedures that consist of best standards of care at the lowest cost.
Deficit Reduction Act 2005
act that states that hospitals will not receive additional payments for cases in which one
of the selected conditions (hospital acquired infections) were not present upon
admission. Includes pressure ulcer and others.
Healthy People 2020
stated the need for quality lives, longer lives, being free from preventable disease.
Better social and physical environments and promotion of healthy behaviors across all
life stages. A comprehensive set of national 10 year health promotion and disease
prevention objectives aimed at improving the health of all Americans. Assessments of
major risks to health and wellness, public health priorities, and issues related to our
nation's health preparedness and prevention
World Health Organization Millennium
goal is to improve economic conditions of world countries. Adopted in 2000 with target
date of 2015. Supported by nursing groups. Goals: end poverty and hunger, universal
education, gender equality, child and maternal health, combat HIV/AID, malaria, etc.
Environmental sustainability, global partnership.
nursing informatics
IOM core competency. How technology is used to prevent errors and improve care.
Major impact on QI. Monitoring of adverse events, insurer's rely heavily on this to
provide coverage. Data mining to determine trends.
Nursing's Social Policy Statement (ANA, 2010)
Addresses social concerns in healthcare and nursing. Organization, delivery, financing
of healthcare. Provision for the public's health. Expansion of nursing and healthcare
knowledge and appropriate application of technology. Expansion of healthcare
resources and health policy. Definitive planning for health policy and regulation. Duties
under extreme conditions
International Council of Nurses (ICN)
focus on advancing nursing worldwide. Nursing in developing countries are often first
line care providers. Nurses care for the disenfranchised.
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genetics
this is a required competency for all nurses. Must be educated in this because it may
influence every facet of patient care.
BSN-in-10 proposal
proposal that state nursing associations require BSN for all RNs 10 years after
graduation from entry-level RN program
mandatory overtime
defined as hours worked in excess of those agreed upon. Research indicates risks of
making errors are significantly increased because of this. This removes ability of nurses
to determine fitness for duty and jeopardizes patient safety as well as nurses' ability to
fulfill legal obligations of licensure. 16 states have restrictions on this
staffing ratios
research shows that insufficient of this is linked to poorer patient outcomes, lengthened
hospital stays, and increased chance of patient death. Also a factor in nurse
dissatisfaction and burn out.
Registered Nurse Safe Staffing Act 2010
requires medicare-participating hospitals to establish unit specific staffing plans, utilizing
a committee, comprised of at least 55% nurses. Unfortunately it keeps being declined
each year
magnet hospitals
recognized by the ANCC, measure the strength and quality of nursing. Where nursing
delivers excellent patient outcomes, have high level of job satisfaction, low staff nurse
turnover, appropriate grievance resolution. Indicated nursing involvement in data
collection and decision making in patient care. Value staff nurses and have appropriate
personnel mix.
IOM Report - the Future of Nursing key messages
Nurses should practice to the full extent of education and training. Nurses should
achieve higher levels of education and training through an improved education system
that promotes seamless academic progression. Nurses should be full partners with
other healthcare professionals, in redesigning healthcare in the US. Effective workforce
planning and policy making require better data collection and information infrastructure
IOM Report - the Future of Nursing key recommendations
Implement nurse residency programs. Increase proportion of nurses with baccalaureate
degree to 80% by 2020. Remove scope of practice barriers. Expand opportunities for
nurses to lead and diffuse collaborative improvement efforts. Double the number of
nurses with a doctorate by 2020. Ensure that nurses engage in lifelong learning.
Prepare and enable nurses to lead change to advance health. Build an infrastructure for
the collection and analysis of inter-professional health care work force data
"Best Care at Lower Cost"
Institute of Medicine. States that Americans would be better served by a more nimble
health care system that is consistently reliable and that constantly, systematically, and
seamlessly improves. Also concluded that a substantial proportion of US health care
expenditures is wasted, leading to little improvement in health or quality of care
Patient Protection and Affordable Care Act (PPACA 2010)
provides Medicaid or subsidized coverage to qualifying people with incomes up to 400%
of poverty, beginning in 2014. Provided Health Insurance Marketplace. Goal is to
decrease the number of uninsured Americans.
Health Insurance Marketplace
a new way to get health insurance. Was designed to help people more easily find health
insurance that fits their budgets. Each plan in this must offer comprehensive coverage,
from doctors to hospital visits. Brought about by the PPACA
pay for performance
strategy using financial incentives to reward providers for the achievement of a range of
payer objectives, including delivery efficiencies, submission of data and measures to the
payer, and improved quality and patient safety
Healthcare Effectiveness Data and Information Set (HEDIS)
tool used by more than 90% of America's health plans to measure performance in
important dimensions of care and service. Developed by National Committee for Quality
Assurance (NCQA). Compare performance of health plans. Measures issues like
medication use, controlling high blood pressure, breast cancer screening, etc.
Excess readmissions
when patients are soon readmitted after discharge. Hospitals now have financial
incentive to prevent this.
Multipayer system
payers include both private insurance companies and the government. This includes the
US.
single-payer system
having one entity such as government run the organization, collect all health care fees,
and pay out all health care costs.
The Health Care Imperative: Lowering Costs and Improving Outcomes
IOM workshop summary that estimates excess costs in six domains: unnecessary
services, services inefficiently delivered, prices that are too high, excess administrative
costs, missed prevention opportunities, and medical fraud
Prospective Payment System
Grouped inpatient hospital services for Medicare patients into DRGs (diagnosis-related
groups) with a fixed reimbursement amount with adjustments based on case severity,
rural/urban/regional costs, and teaching costs; RUGs (resource utilization groups) in
long-term care.
primary health care
dealing with common health problems and preventive measures that account for 80-
90% of visits to clinicians. Includes family practice physicians and nurse practitioners. In
primary care centers, urgent care centers, family planning centers.
secondary health care
problems that require more specialized clinical expertise, such as hospital care for a
patient with a myocardial infarction or stroke. Include physicians in certain specialities
and advanced practice nurses. In hospital-based clinics, emergency departments, same
day surgery units.
tertiary health care
management of complex disorders such as pituitary tumors and congenital
malformations. Includes subspecialist physicians such as surgeons and hematologists
and advance practice nurses. In complex medical centers.
fee-for-service
arrangement in which everything a provider does for a patient leads to a bill generated
and a fee paid
multispecialty group practice
when physicians from different specialties united to share income, expenses, facilities,
equipment, and support. Resulted in better ability to provide comprehensive care.
community health centers
regionalized services for vulnerable geographic populations with an emphasis on
primary care and education. Objective is to ensure that everyone who needs care has
access regardless of ability to pay. Mainly rely on nurses.
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health maintenance organizations (HMOs)
prepaid, group-managed care plans that allow subscribers to receive all the medical
services they require through a group of affiliated providers. Subscribers may only pay a
copayment. Popular with employers who support concept of managed care. Associated
with Medicare as well.
preferred provider organizations (PPOs)
allows a third-party payer (like a health insurance company) to contract with a group of
health care providers to provide services at a lower fee in return for prompt payment
and a guaranteed volume of patients and services. Includes preferred provider
arrangement
preferred provider arrangement
type of PPO in which a contract is made with an individual health care provider rather
than a group of providers.
point-of-service plan
a type of PPO that encourages the use of specified physicians and services but pays a
portion of expenses for referrals made to physicians outside the organization by the
patient's primary care physician.
accountable care organization (ACO)
emerged from PPACA. Offers incentives to provide integrated, well-coordinated care to
patients. Departs from fee-for-service model
medical home
enhanced model of primary care that provides whole-person, accessible,
comprehensive, ongoing, and coordinated patient-centered care
medical neighborhood
medical home model and constellation of other clinicians providing health care services
to patients within it, along with community and social service organizations as well as
state and local public health agencies.
care coordination
deliberate organization of patient care activities between two or more participants
(including patient) involved in a patient's care to facilitate the appropriate delivery of
healthcare services
out-of-pocket payment
paying for healthcare with cash payments. Simple method of financing that is incredibly
rare because most families cannot afford high costs
individual private insurance
organizations or companies that provide insurance by having their members pay
monthly premiums by themselves or in combination with employer payments. Premiums
tend to be higher than those for managed care plans, but members can choose own
physician and services desired.
medicare
federally funded health care program part of Social Security Act. Health insurance for
older adults (over 68 years). Covers hospital care, extended care, and home health
care. Includes permanently disabled workers and dependents if they qualify for Social
Security benefits. Part A is covered by government and includes inpatient hospital costs.
Part B is voluntary and is a monthly premium. Covers most outpatient costs of physician
visits, medications, etc. Not everything is covered by this though so private insurance is
often recommended.
diagnosis-related groups
used by government in an effort to control rising health care costs by paying the hospital
a fixed amount that is predetermined by medical diagnosis or specific procedure rather
than by actual cost of hospitalization and care. This is what Medicare was converted to
in 1983.
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medicaid
Part of Social Security Act. Federally funded public assistance program for people of
any age who have low incomes. Blind, older adults, and disabled are covered by
supplemental security benefits.
Children's Health Insurance Program
Part of Social Security Act. Helps states insure low-income children who are ineligible
for Medicaid but cannot afford private insurance.
inpatient
person who enters a hospital and stays overnight for an indeterminate time (days to
months)
outpatient
those who are not hospitalized overnight but who require diagnosis or treatment
ambulatory care
agencies that deliver outpatient medical care. May be located in hospitals or
freestanding service provided by group of health care providers who work together or
maybe managed by an APRN. Located in convenient areas. Offer walk-in services.
Include urgent care and same-day surgical centers
hospital at home program
when patients are treated in own homes by appropriate health care professionals.
Average patient length of stay was shorter and overall costs were at third lower.
Patients had lower change of developing delirium or requiring sedatives.
extended-care services
provide medical and nonmedical care for people with chronic illnesses or disabilities.
Include transitional subacute care, assisted-living facilities, long term care facilities,
homes for medically fragile children, retirement centers.
parish nursing
expanding area of specialty nursing practice that emphasizes holistic health care, health
promotion, and disease-prevention activities. Utilizes faith community.
respite care
type of care provided for caregivers of homebound ill, disabled, or older patients. Main
purpose is to give the primary caregiver some time away from the responsibilities of
day-to-day care
hospice
program of palliative and supportive care services providing physical, psychological,
social, and spiritual care for dying people, their families, and their loved ones. Nurses
continue to care for patient's family during bereavement period of up to 1 year.
palliative care
evolved from hospice experience. Not restricted to end of life but can be used from point
of initial diagnosis. Focuses on relief of physical, mental, and spiritual distress.
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