1. The Health Care Delivery System
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2. Challenges to Health Care
Uninsured patients
Reducing health care costs while maintaining high- 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
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3. National Priorities Partnership
Promote best practices
Promote prevention, treatment, and intervention practices for the leading causes of mortality
Ensure person- and family-centered care
Make care safer
Promote communication and care coordination
Make quality care affordable
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4. Institute of Medicine (IOM)
Nurses need to be transformed by:
Practicing to the full extent of their training
Achieving higher levels of education through an education system that provides seamless progression
Becoming full partners with physicians and other health care providers in redesigning the health care system
Improving data collection and the information infrastructure for effective workforce planning and policy making
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5. Health Care Regulation and Reform
Regulatory and competitive approaches
Professional standards review organizations (PSROs)
Created to review the quality, quantity, and cost of hospital care provided through Medicare and Medicaid
Utilization review (UR) committees
Review admissions, diagnostic testing, and treatments ordered by physicians who cared for patients receiving Medicare
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6. Health Care Regulation and Reform (Cont.)
Prospective payment system (PPS)
Diagnosis-related groups (DRGs)
Capitation
RUGs
Profitability
Managed care
“Never Events”
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7. Health Care Regulation and Reform (Cont.)
Patient Protection and Affordable Care Act
Access to health care for all
Reducing costs
Improving quality
Provisions include
Insurance industry reforms
Increased funding for public programs
Improved coverage for children
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8. Health Care Settings and Services
1. Preventive
2. Primary
3. Secondary
4. Tertiary
5. Restorative
6. Continuing
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9. Preventive and Primary Health Care
Preventive Care
Reduces and controls risk factors for disease
Primary care
Focuses on improved health outcomes
Requires collaboration
Health promotion programs lower overall costs
Reduces incidence of disease
Minimizes complications
Reduces the need for more expensive resources
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10. Secondary and Tertiary Care
Focus: Diagnosis and treatment of disease
Disease management is the most common and expensive service of the health care delivery system
Postponement of care by uninsured contributes to high costs
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11. Secondary and Tertiary Care
Hospitals
Work redesign
Discharge planning
Intensive care
Psychiatric facilities
Rural hospitals
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12. Restorative Care
Serves patients recovering from an acute or chronic illness/disability
Helps individuals regain maximal function and enhance quality of life
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13. Services Commonly Provided by Home Health Nurses
Provision of medically related 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.
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14. Rehabilitation
Includes physical, occupational, and speech therapy, and social services
Begins on admission
Focuses on preventing complications
Maximizes patient function and independence
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15. Extended Care Extended care facility
Provides intermediate medical, nursing, or custodial care for patients recovering from acute illness or disabilities
Intermediate care/skilled nursing facility
Provides care for patients until they can return to their community or residential care location
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16. Continuing Care
For people who are disabled, functionally dependent, 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
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17. Continuing Care: Assisted Living
Long-term care setting
Home environment
Greater resident autonomy
No fee caps
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18. Continuing Care: Respite Care
Respite care provides short-term relief or “time off” for people providing home care to an individual who is ill, disabled, or frail.
Settings include home, day care, or health care institution with overnight care.
Trained volunteers enable family caregivers to leave the home for errands or social time.
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19. Quick Quiz!
A patient who needs nursing and rehabilitation following a stroke would most benefit from receiving care at a: A. primary care center. B. restorative care setting. C. assisted-living center. D. respite center.
Answer: B
Rationale: The goals of restorative care are to help individuals regain maximal functional status and enhance quality of life through promotion of independence and self-care.
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20. Adult Day Care Centers
Provide a variety of health and social services to specific patient populations who live alone or with family in the community
May be associated with a hospital or nursing home or may operate independently
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21. Hospice Care
Family centered care that allows patients to live with comfort, independence, and dignity while easing the pains of terminal illness.
Focuses on palliative (not curative) care
Many hospice programs provide respite care, which is important in maintaining the health of the primary caregiver and family.
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22. Issues in Health Care Delivery
Nursing shortage
Competency
Quality and safety in health care
Pay for performance
Patient satisfaction
Magnet Recognition Program
Nursing-sensitive outcomes
Nursing informatics and technological advancements
Globalization of health care
Vulnerable populations
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23. Quick Quiz!
Technological advances in health care: A. make the nurse’s job easier. B. depersonalize bedside patient care. C. threaten the integrity of the health care industry. D. do not replace sound personal judgment.
Answer: D
Rationale: In many ways technology makes your work easier, but it does not replace nursing judgment. For example, it is your responsibility when managing a patient’s IV therapy to monitor the infusion to be sure that it infuses on time and without complications. An electronic infusion device provides a constant rate of infusion, but you need to be sure that you calculate the rate correctly. The device sets off an alarm if the infusion slows, making it important for you to respond to the alarm and troubleshoot the problem. Technology does not replace your critical eye and clinical judgment.
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24. Quality and Performance Improvement
Quality data
Quality improvement (QI)
Performance improvement (PI)
Quality improvement programs
Models
Patient Self-Determination Act (PSDA)
Six Sigma or Lean
Rapid-cycle improvement or rapid-improvement event (RIE)
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25. The Future of Health Care
Change opens up opportunities for improvement.
Health care delivery systems need to address the needs 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.
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