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caring foundations

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caring foundations

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  • 1. Chapter 2 The Health Care Delivery System

2. Challenges to Health Care Reducing health care costs while maintaininghigh-quality care for patients Improving access and coverage for more people Encouraging healthy behaviors Earlier hospital discharges result in more patients needing nursing homes or home care. 3. Emphasis on Population Wellness Health ServicesPyramid Managing healthinstead of illness Emphasis on wellness Injury prevention programs{Fig 2-1 here} 4. National Priorities Partnership National Priorities: Patient and family engagement Population health Safety/eliminating errors as possible Care coordination Palliative care for advanced illnesses Overuse/reducing waste 5. Institute of Medicine (IOM) Nurses need to be transformed by: Practicing to the full extent of their education andtraining Achieving higher levels of education and training through an improved education system that provides seamless progression Becoming full partners, with physicians and other providers, in redesigning the health care system Improving data collection and the information infrastructure for effective workforce planning and policy making 6. Case Study Amy Sue Reilly is a 15-year-old white female of Irishdescent. She is a freshman at a Catholic high school. Although her parents are divorced, Amy Sue reports that her family (she has two brothers and lives with her mother) is very close, and that her parents work together to meet all their childrens needs. Amy Sue has had asthma since she was 5 years old. She has been able to control her asthma by taking oral medications and by using inhalers when needed. 7. Health Care Regulation and Competition Regulatory and competitive approaches Professional standards review organizations(PSROs) Created to review the quality, quantity, and cost of hospitalcare provided through Medicare and Medicaid Utilization review committees (URs) Review admissions, diagnostic testing, and treatments provided by physicians who cared for patients receiving Medicare 8. Health Care Regulation and Competition (contd) Prospective payment system (PPS) Diagnosis-related groups (DRGs) Capitation Resource utilization groups (RUGs) Profitability Managed care 9. Health Care Regulation and Competition (contd) Patient Protection and Affordable Care Act Access to health care for all Reducing costs Improving quality Provisions include Insurance industry reforms Increased funding for community health centers Increased primary care services Improved coverage for children 10. Health Care Settings and Services1. Preventive2. Primary3. Secondary4. Tertiary5. Restorative6. Continuing 11. Health Care Accreditation/ Certification Reasons: To demonstrate quality and safety To evaluate performance, identify problems, anddevelop solutions Accreditation earned by the entire organization Specific programs or services within an organizationearn certifications. The Joint Commission and others 12. Preventive and Primary Health Care Preventive Care Primary care Focuses on improved health outcomes for an entire population Requires collaboration among health professionals, health care leaders, and community members Health promotion lowers overall costs: Reduces incidence of disease Minimizes complications Reduces the need for more expensive resources Occurs in home, work, and community settings 13. Secondary and Tertiary Care Also called acute care Focus: Diagnosis and treatment of disease Disease management is the most common andexpensive service of the health care delivery system. 20% require 80% of health care spending. Fastest growing age group of uninsured? Postponement of care by uninsured 14. Secondary and Tertiary Care (contd) SettingsHospitals Rural HospitalsIntensive Care Units Psychiatric Care Resource efficiency, word redesign Discharge planningnurses role 15. Restorative Care Serves patients recovering from an acute or chronic illness/disability Helps individuals regain maximal function and enhance quality of life Promotes patient independence and self-care abilities Requires multidisciplinary approach Settings:Home CareRehabilitationExtended Care 16. Restorative Care: Home Care Provision of medically related professional andparaprofessional services and equipment to patients and families in their homes for health maintenance, education, illness prevention, diagnosis and treatment of disease, palliation, and rehabilitation Involves coordination of services Focuses on patient and family independence Usually reimbursed by government (such as Medicare and Medicaid in the United States), private insurance, and private pay sources 17. Restorative Care: Rehabilitation Focus: To restore patients to their fullest physical,mental, social, vocational, and economic potential Includes physical, occupational, and speech therapy, as well as social services Occurs in many health care settings, both inpatient and outpatient 18. Restorative Care: Extended Care Extended care facility Provides intermediate medical, nursing, or custodialcare for patients recovering from acute illness or disabilities Skilled nursing facility (intermediate care) Provides care for patients until they can return totheir community or residential care location 19. Continuing Care For people who are disabled, functionallydependent, or suffering a terminal disease Available within institutional settings or in the home: Nursing Centers or Facilities Assisted Living Respite Care Adult Day Care Centers Hospice 20. Continuing Care: Nursing Centers or Facilities Provide 24-hour intermediate and custodial care Nursing, rehabilitation, diet, social, recreational, andreligious services Residents of any age with chronic or debilitating illnessOmnibus Budget Reconciliation Act of 1987 Regulated by standards: Interdisciplinary functional assessment is thefocus of clinical practice: MDS, RAIs 21. Continuing Care: Assisted Living Offers a long-term care setting with a home environment and greater resident autonomy Provides services such as laundry, assistance with meals, personal care, housekeeping, and 24-hour oversight Allows residents to live in their own units 22. Respite Care The service provides short-term relief or time offfor persons providing home care to an ill, disabled, or frail older adult. Settings include home, day care, or health care institution with overnight care. Trained volunteers allow family caregivers to leave the home for errands or social time. 23. Adult Day Care Centers Provide a variety of health and social services tospecific patient populations who live alone or with family in the community May be associated with a hospital or nursing home or may operate independently Offer services to patients such as daily physical rehabilitation and counseling 24. Hospice Family-centered care that allows patients to liveand remain at home Focuses on palliative (not curative) care: comfort, independence, and dignity Provides patient and family support during terminal illness and time of death Many hospice programs provide respite care, which is important in maintaining the health of the primary caregiver and family. 25. Issues in Health Care Delivery Nursing shortage Competency Evidence-based practice Quality and safety in health care/ Patient-centered care Health care organizations are being evaluated on the basis of outcomes such as prevention of complications, patients functional outcomes, and patient satisfaction. 26. Issues in Health Care Delivery (contd) Magnet Recognition Program Nursing-sensitive outcomes Nursing informatics and technologicaladvancements Globalization of health care 27. The Future of Health Care Change opens up opportunities for improvement. Health care delivery systems need to address theneeds of the uninsured and the underserved. Health care organizations are striving to become better prepared to deal with these and other challenges in health care. The solutions necessary to improve the quality of health care depend largely on the active participation of nurses.