Health Care Delivery System Exam Guide
Comprises of all those involved in healthcare including: institutional settings, agencies, policies,
... [Show More] payment
plans, providers, and clients and families
Health Care Delivery System
The levels of health care include:
Primary
Secondary
Tertiary
This type of health care helps with health promotion and illness prevention; it can be directed at an
individual or a community
Primary Prevention
Some examples of providing primary prevention include:
adequate nutrition; weight control; exercise; stress management; immunizations; identifying measures to
prevent disease; identifying risk factors for disease;
This type of health care helps with diagnosis and treatment; it is traditionally the largest segment service
in the health care system
Secondary Prevention
This type of health care helps with rehabilitation and health restoration and palliative care; also helps with
the process of restoring to optimum level of wellness or to highest level of health that one is capable of
Tertiary Prevention
Some goals for Rights and Health Care include:
improving quality of health care; making the system responsive to client's needs; protecting client's
autonomy and independence;
In 1973, American Hospital Association (AHA) published:
A Patient's Bill of Rights
Types and Services recognized in the healthcare setting include:
different institutions providing various types of care; changes being seen in response to changes in our
healthcare system; trend toward community-based care; nurses involved in care in all settings
Community-based care is:provided in many different settings and focuses on health promotion and health restoration across the
lifespan; provides more needs and services outside hospital
Home Setting Nursing Care includes:
assessments, meds, teaching, physical care, family support, collaborate with other healthcare services
Home Setting care is influenced by:
prospective payment systems or DRG's; elders not requiring institutionalization; those who desire to stay
in home; more clients choosing to die at home
Home Setting care is provided through:
community health departments; visiting nurses' associations; hospital-based care managers; home-health
agencies
Also known as diagnostic related groups which assist with earlier discharges and influenced through
prospective payment system
DRG's
Hospitals and Crisis Intervention Centers are examples of:
Acute Care Settings
Employ more nurses than any other settings
Hospitals
Help with diagnosis and treatment; provided for those too ill to be cared for at home; focused on the
acute-care needs of clients
Crisis Intervention Centers
Physician Offices are an example of:
Primary Care Settings
Physician Offices assist with:
physicals, minor illnesses, minor surgeries, OB/Gyn care, well-child care, counseling and referrals
Ambulatory Care Centers are:
located for convenience; may be "walk-in"; may provide variety of services such as urgent/emergency
care; outpatient surgery; general healthcare
Some examples of Specialized Care Centers are:
day-care centers; mental health centers; rural health centers; schools; industrial; shelters; rehab centersSome Long-Term Care Settings are:
extended care facilities; life care centers; rehab; psychiatric
Special services available to terminally ill patients; may include inpatient/home care; committed to
maintaining quality of life and dignity of dying
Hospice
Some measures in order to maintain the quality of life and dignity of dying of those in hospice include:
open communication; symptom management; comfort measures; support of family
Volunteer agencies, religious agencies, government agencies, and public health are some examples of:
Other health care centers
Some providers of health care include:
nurses; physicians; physician assistants; physical therapist; respiratory therapist; occupational therapist;
speech therapist; dietician; pharmacist; social worker; chaplain; dentists; optometrists; nurse practitioners;
psychologists; lab personnel; diagnostic services; administrative; community workers;
Some trends in healthcare include:
healthcare services; organization; access; healthcare coverage; costs; Medicare/Medicaid; distribution of
resources; planned change
These are goals to provide cost-effective, quality care that focuses on improved quality outcomes;
planned care to ensure standards are met and costs minimized; national trend toward this framework of
care; choise will be between organizations NOT health care providers
Managed Care Systems
HMO's are an example of:
Managed Care Systems
Coordinates client's healthcare to maximize outcomes and contain costs; focus to enhance continuity of
care; provides protocols and timetables and follows client from diagnosis to home
Case management
A delivery model that brings all services and care providers to the clients; involves cross-training and
collaboration; clients will perceive improved care and service
Patient Focuses Care
Client-centered method where one nurse is assigned to comprehensive care of a group during an 8-12
hour shift and provides consistent contact with client during the shiftCase Method
Focuses on jobs to be completed, centralized authority, and efficiency
Functional Method
Some disadvantages of the Functional Method include:
task oriented, fragmented care, "nonquantifiable" aspects of care may be overlooked
Individualized care led by a professional nurse (RN) and consists of RN's, LPN's and Nurse's Aids
(UAP); they coordinate care during a shift with delegation of appropriate tasks
Team Nursing
One nurse responsible for total care for a number of clients 24/7; assesses patients and develops plans of
care and evaluates effectiveness
Primary Nursing
The manager of the client's care who plans, coordinates, and communicates with client
the RN
Some examples of financing healthcare are:
insurance companies, PPO's (preferred providers), Preferred Provider Arrangement (PPA's), HMO's
(Health Maintenance Organization)
Majority of these are private, profit-making; manage to provide a profit as well as services to policy
holders; based on shared risk; limits on coverage; have influence and power by limiting healthcare
decisions between provider and client; involved in standards of care
Insurance Companies
Insurance companies that have negotiated a contract with a group of healthcare providers to provide
services at a lower fee in return for prompt payment and guaranteed volume of clients
PPO's or Preferred Providers
Healthcare providers outside the group, client would agree to pay additional out-of-pocket expenses;
arrangement made with a single provider instead of a group
PPA's or Preferred Provider Arrangement
Fees are flat rate per month; Primary health providers are often employed and receive a set salary;
may/may not have choice of providers; incentive for preventive medicine, emphasizes client wellness
HMO's or Health Management Organization
Some examples of what HMO's help cover:routine, preventive care, care for illness, hospitalizations, sometimes Rx, outpatient care,
Two major government financing providers are:
Medicaid and Medicare
Insurance program for persons over 65, healthcare costs have been larger than anticipated, hx abuse and
fraud
Medicare
Federally funded program for persons of LES (elderly women and children)
Medicaid
Two regulatory agencies are:
joint commissions; DNV Healthcare (Det Norske Veritas)
Non-governmental agency that approves or accredits hospitals; profound impact on how these agencies
operate
Joint Commission
Works with healthcare providers to improve healthcare delivery through risk management
DNV Healthcare
Some problems in healthcare delivery are:
cost of healthcare; cost of new technology; construction of new facilities; DRG's; population of aging;
salaries and diversity of providers; supplies and drugs; lack of competition
Originated in 1983 when Medicare converted to a "prospective payment plan"; hospital receives
predetermined, fixed rate; determined by diagnosis or procedure regardless of actual cost; pays only the
amount pre-assigned to the diagnosis
DRG's
Some nursing implications considering healthcare include:
trends in approaches to healthcare may actually benefit nurse; nurses can provide cost-effective care for
clients in a variety of settings; studies show a need for more advanced practice nurses
Some things to know for the admission process:
the unit to receive patient usually notified by admission office; room assignment made; room prepared;
admission assessment; physician notified of admission; nurse responsible to assess the needs of the client
and the family; documentation; wait for physician's physical and admission orders
Some things to know for the transfer process:goal to make transfers as smooth as possible; clients have to adjust to new settings, roommates, routines,
care providers; all can cause stress and anxiety; nurse responsible for meeting the comfort, safety and
knowledge needs of the client and family; order from a physician; notify appropriate people; care of
personal property; give report
Some things to know about the discharge process:
begin to plan for discharge on day 1; usually coordinated by nursing; requires careful planning, teaching
and documentation; involve the patient and family; discharge assessment; discharge instructions by RN
only; accompany to door
What is AMA (against medical advice)?
legally free to do so; a form must be signed releasing physicians and facility from legal responsibility;
witnessed; part of permanent record
The affordable care act is when:
young adults can remain on parental insurance until age 26; lowers the cost of meds for people on
medicare; removes lifetime limits on coverage; goal is to reduce the number of uninsured Americans;
fines given for those without coverage
Service Excellence is achieved when:
patients perception of care is quality; core measures are taken; HCAHPS; rounding for outcomes; bedside
report is done; key words are used at key times
Provides safe consistent communication between caregivers; reduces break in communication during
handoff report; Joint Commission recommends this as best practice
SBAR
SBAR stands for:
Situation
Background
Assessment
Recommendation
Nutrition counseling for young adults with a strong family history of high cholesterol is a good example
of what?
Primary Prevention Activity
Public health agencies are funded by governments to:
investigate and provide health programsIn most cases, clients must have a primary care provider in order to receive health insurance benefits. If a
client is in need of a primary care provider, it is most appropriate for the nurse to recommend a:
family practice physician
The most significant method for reducing the ongoing increase in the cost of health care in the US
includes controlling:
competition among drug and medical equipment manufacturers
A client seeking to control health care costs for both preventive and illness care. Although no system
guarantees exact out-of-pocket expenditures, the most prepaid and predictable client contribution would
be seen with:
a health maintenance organization (HMO)
The ANA's Health System Regorm Agenda included:
Case management should be focused on clients with enduring health care needs
The Pew Commission competences for future practitioners included the need for providers to become
skilled in the:
use of technology
What is a characteristic of nursing care provided in community-based health?
Clients are individuals in groups according to their geographic commonalities.
When performing collaborative health care, the nurse must implement:
rely on the expertise of other healthcare team members
A large disaster in community resulted in the destruction of many family homes and many individuals
were injured. The assistance of community health nurses and home health nurses is needed. The home
health nurse is most likely to perform an:
assessment and treatment on individual clients [Show Less]