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Healthcare Institutions

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Presentation on theme: "Healthcare Institutions"— Presentation transcript:

1 Healthcare Institutions
Chapter 10: Healthcare Institutions

2 Introduction What Institutions Make Up the Healthcare System?
What Types of Inpatient Facilities Exist in the United States? What Types of Outpatient Facilities Exist in the United States?

3 Introduction What Do We Mean by Quality of Healthcare Services?
How Care Health Care Be Coordinated Among the Multiple Institutions that Provide Health Services? What Types of Healthcare Delivery Systems are Being Developed and How Can They Ensure Coordination of Health care?

4 Introduction How Can Electronic Medial Records Facilitate Coordination of Care and Improve Quality? How Is Technology Being Used to Improve the Quality of Care? What Mechanisms Are Being Used to Monitor and Ensure the Quality of Health Care? Can Disclosure of Medical Errors Contribute to Quality of Care?

5 Scenarios Health Care Institutions
George didn’t have health insurance and went to the emergency room whenever he needed care. They emergency department treated him but then tried to get him connected to a primary care facility. He couldn’t go to the Veteran’s Administration facilities because he wasn’t a veteran. They sent him to the local community health center which they called the “safety-net” provider. George did go to the community health center where they tried to treat his problems and get him his medicines despite not having insurance. When he got sick, however, George went back to the emergency department. Even George agreed that it wasn’t the best way to get care but wondered what was needed to make the system work better?

6 Scenarios Health Care Institutions
Laura had breast cancer and it had spread. Her medical records were everywhere in the hospital, four doctor’s offices, two emergency rooms, and an outpatient imaging facility. No one seemed to know how to put the system together. Whenever her old records were essential they asked her to go get a copy of the records and bring them to her next appointment. That worked for a while but when she ended up in the emergency room her records just weren’t available. There must be a better way, Laura through to herself. Hasn’t the health care system discovered the Internet yet?

7 Scenarios Health Care Institutions
Fred ended his walk one day in the emergency room. He seemed confused about how to get home. "It looks like we are dealing with Alzheimer’s,” Fred’s doctor told Fred’s wife Sonya at their next appointment. Taking care of Fred at home was not easy. Home health aides and occasional weekend relief called "respite care" eased the burdens for a while. The new assisted living facilities looked attractive, but Fred’s family just couldn’t afford it. When Fred fell and broke his hip he required hospitalization for surgery. The hospital discharge planner arranged for a skilled nursing home for rehabilitation services. After a few weeks of rehabilitation the only alternative was long term or custodial care in a nursing home. The care at the nursing home was not what the family had expected. The staff did clean him up before the announced family visits but when the family arrived for an unannounced visit they were shocked to see Fred lying half naked in the wheelchair. The end came almost two years from the day they moved him to the nursing home. Looking back the family asked, how can we do better to address the needs of Alzheimer’s patients?

8 Characteristics of Healthcare Quality: National Committee for Quality Assurance
Meaning Examples How measured? Access and Service Access to needed care and good customer service Enough primary care physicians and specialists Satisfaction of patients in terms of problems obtaining care Patient satisfaction surveys, patient grievances and follow-up, interviews with staff

9 Characteristics of Healthcare Quality: National Committee for Quality Assurance
Meaning Examples How measured? Qualified providers Personnel licensed and trained and patients satisfied with services System for checking credentials, sanctions Patient satisfaction with providers of care Presence of system for checking credentials Patient satisfaction surveys

10 Characteristics of Healthcare Quality: National Committee for Quality Assurance
Meaning Examples How measured? Staying healthy Quality of services that help people maintain good health and avoid illness Presence of guidelines for appropriate clinical services Evidence that patients are receiving appropriate screening tests Review of independently-verified clinical records Review of responses from patients

11 Characteristics of Healthcare Quality: National Committee for Quality Assurance
Meaning Examples How measured? Getting better Quality of services that help people recover from illness Presence of method for evaluating new procedures, drugs, and devices to ensure that patients have assess to the most up-to-date care Providing specific services, such as smoking cessation Review of independently-verified clinical records Interviews with staff

12 Characteristics of Healthcare Quality: National Committee for Quality Assurance
Meaning Examples How measured? Living with illness Quality of services that help people manage chronic illness Programs to assist patients to manage chronic conditions like asthma Provision of specific services, such as eye examinations for diabetics Review of independently-verified clinical records Interviews with staff

13 Clinician-patient relationship
Type of coordination of care, intended functions and challenges with implementation Type of coordination Intended function Challenges with implementation Clinician-patient relationship Continuity as a mechanism for ensuring Coordination Development of individual relationships built on knowledge and trust over extended periods of time Multiple clinicians involved in care Team rather than individual concept of primary care Frequent changes in insurance coverage require change in health professionals

14 Type of coordination of care, intended functions and challenges with implementation
Institutional Coordination of individual’s information between institutions needed to inform individual clinical and administrative decision making Different structures and governance often lead to lack of coordination between inpatient facilities and between inpatient and outpatient facilities

15 Type of coordination of care, intended functions and challenges with implementation
Financial coordination Implies that a patient has comprehensive coverage for services provided by the full range of Institutions Maximize the efficiency of the care received and to minimize the administrative effort required to manage the payment system Lack of comprehensive insurance coverage often means that essential services cannot be delivered or cannot be delivered at the most efficient or effective institutional site

16 Type of coordination of care, intended functions and challenges with implementation
between Health care and Public health Coordination of services between clinical care and public heath requires communication to ensure follow-up and to protect the health of others Lack of coordination of services between public health services and clinical care is often based on lack of communication


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