Presentation on theme: "Community-Based HealthCare"— Presentation transcript:
1 Community-Based HealthCare PPP by Marianne McAuley , BSN, MS, RN Revised KBurger1008 LECTURE # 20 FALL 2009By using public health principles, the nurse is able to better understand the types of environments in which clients live and the types of interventions necessary to keep clients healthy.Healthy communities –healthy people – healthy nation
2 What is Community-Based Health Care? Part of holistic nursing practiceFocuses on primary health interventions – [ preventative health care ]Considers unique needs of a specific geographic region and population of that community.Diverse settings – rural, urban, etc.Care provided to people who live in a specific geographic area - PHN-HempsteadCare to people with common needs - TB follow-up, Sr. CitizensMany different types of settingshospitals, long-term care, clinics, home care, doctors offices, schools, day care centers, Elder-care Centers
3 HEALTHY PEOPLE 2010 Health care goals for the nation Increase quality & years of healthy life for AmericansRemove disparities in health careThe US Department of Health & Human Services Public Health Service designed this program to improve the overall health status of people living in this country.Emphasizes link between individual health & community health.The health of the community determines the health of the nationThe healthy people initiative was initially created in 1990 to establish health care goals for the year 2000.In 2000 these goals were revised for 2010.2 overarching goals for 2010:Increase quality & years of healthy life for Americans2. Remove health care disparitiesIs the higher rate of breast cancer mortality in black American women in contrast to white American women due to decreased access (disparity ) to mammograms.
4 PUBLIC HEALTH NURSING Understand needs of a population PUBLIC HEALTH PROBLEMSPrevalence of overweightUnder immunization of childrenIncrease of STDDrug resistant strains of TBToxic environmental conditionsNew diseases - AIDS, West Nile VirusBMI on assessment form25-29 = overweight>30 = obesity
5 Components of a Community Assessment PopulationDemographic census dataPredominant cultural groupStructureLocation of servicesLocations where people congregateHousingeconomySocial SystemTransportation systemHealth system – gaps in services?Government
6 Types of Preventive Services Primary:Decrease risk to a client for diseaselife-style modificationsSecondary:Early intervention to alleviate diseaseDiagnosis & prompt intervention to decrease severity of a diseasescreeningsTertiaryMinimize effects of chronic conditionsrehabilitation activitiesPrimary: can be an individual or communityTraditionally US health care focused on disease preventionShift to health promotionLifestyle modifications: smoking cessation, diet education, weight reduction, immunizations, safe environment (seat belts, side air bags, smoke detectors)Secondary:early detection & interventionsscreenings, acute care, surgeryTertiary:rehab activities to obtain optimal level of functioning:MI: cardiac rehab, Stroke
8 National Public Agencies U.S. Dept. of Health & Human Servicesadministratively responsible for public health care servicesU.S. Public Health Servicesoversees delivery of public servicesVeteran’s Administrationhealth care for members of armed forcesFinanced with Federal tax dollars
9 Agencies of USPHS CDC- prevents transmission of communicable diseases FDA - Protects public from unsafe drugs, food, cosmeticsNIH – National Institute of Healthconducts research & education for specific diseasesAHRQ – Agency for Health Care Research & Qualityidentifies standard of care for high-volume diseasesCDC: Anthrax management, Standard Precautions,Flu vaccines,West Nile Virus – sprayingNIH: strokeAHCPR: committee of expertsprotocols: pressure ulcers, pain
10 State and Local Health Departments New York State Department of Health NYSDOHSuffolk County Department of Health SCDOHFinanced with state tax dollarsEach state varies in provision of public health servicesL.I.: Nassau & Suffolk Health Depts.: clinics: maternal-child, TB
11 Voluntary Agencies ANA, AMA American Heart Association American Cancer SocietyMeals on WheelsSupport GroupsAs a nurse with a community focus, you want to be aware of the services of community agencies.These are a resource that you can use to assist clients with their needs.We hope that this is 1 outcome of this community project.ANA, AMA: legislative influenceACS, AHA, ADA:educational resources to general public & health care professionals.Example: ACS: Hauppauge, AHAS: Bohemia - send materialsCommunity nurse: collect file of educational materials for clientsSupport groups: Reach to Recovery, AA, I Can Cope etc.
12 ROLES OF THE NURSE Caregiver Collaborator Advocate Educator Manager Change agentCounselorVariety of rolesindependentdependentInterdependentCollaborator – work with interdisciplinary teamAdvocate – help them walk through systemEducator – help clients assume responsibility for their own care.See JCAHCO requirements for dischargeManager – seek new & more effective solutions to problems – evidence-based practiceCounselor – identity & clarify health problems. Direct to appropriate resources.
13 FINANCIAL ASPECTS OF HEALTH CARE US: private insurance modelPast: Retrospective System: fee-for-servicePresent: Prospective System: predetermined fixed amounts of paymentsManaged CarePayment System: 1983: ProspectiveDiagnosis Related Groups (DRGs)Length of Stay (LOS)Reform in health care motivated by health care costsUS spends more on health care than any other nation, yet not all citizens have health care coveragePAST: Retrospective: provider billed whatever it cost - no incentive for cost-control. Cost-based system.Costs of health care spiraling out of control1983 Congress established the PPS – this eliminated cost-based reimbursementProspective: receive set amount - based on DRGSControl of costs shifted from health care providers to insurers
14 Managed Care access, cost & quality are controlled emphasis on prevention & primary carenot a place, but an organizational structureprimary care physician - gatekeeperSystem of providing & monitoring careGoal: delivery of services in most cost-efficient mannerMonitors delivery of services - quantityrestricts access to expensive procedures & providersPrimary Care Physician: gatekeeperreferral to see specialist
15 Types of Managed Care Managed Care Organizations (MCO) - Staff model = physicians employed by the MCO- Group, Network, Independent model = MCO contracts with specific practitioners or groupscapitated rates: a preset flat fee based on membership not servicesreferral needed for specialistsRationale: give consumers preventive services by a primary care providerPrevent problems or minimize their impact means better health for the consumer & less money spent on health care problemsNeed a large membership:collects more money – so it will cover costs of services to membersPatients with low-cost health care needs offset cost of those with high cost health care needs
16 TYPES OF MANAGED CARE PPO [ Preferred Provider Organization ] - members use network of providers- insurance plans and self-insured employersmembers pay extra for providers outside of networkincentive for providers: large # of patients42% growth rate in last 10 yearsNetwork of Providers:pay co-pay only usuallyOutside of network:annual deductiblePPO pays 80% of reasonable & customary charges
17 MEDICAREA type of MCOPart A: inpatient hospital, skilled nursing facility, home, hospice careno premium - paid by Federal gov’tPart B: outpatient costs, physician visitspaid by monthly premiumPart D: [ as of 1/06] prescription coverage Part D: [ as of 1/06] prescription coverage1965:Federal health care program for those over age 651972: expanded to permanently disabled & dependents & ESRDMedicare does not cover full cost of certain services – supplemental insurance recommended.Prospective payment system – fixed fee for DRG: THR, CHF. Co-morbitities factored inPart A: no cost. Must be a US citizen or resident with a visa who has been here for 5 consecutive yearsSNF – skilled care from a licensed nursing staff. Medicare covers 100 days but at a decreasing dollar amount after the first 20 days.Part B. Monthly premium deducted from Social Security check - $88/monthPart D: As of 1/06 provides limited coverage for prescription drugsSelect a Rx plan, meet a deductible
18 MEDICAID For people with low income Jointly administered by Federal government & statesEach state determines eligibility & services90% of long-term care (nursing centers) paid by MedicaidNYS has different criteria for eligibility & provides different services than FloridaSteady increase in # of older adultsMajor concern for financing of LTCMedicaid is the largest payorTaxes would continue to increaseLong-term care insurance is expensive
19 ISSUES IN HEALTH CARE Cost oversupply of specialized providers focus on treatment of disease, not preventionsurplus of hospital bedsconsumers are passiveaging of populationadvanced technologylawsuitsCosts rising at 10% a yearFar above inflation rateHealth Care Costs; 15% of GNPUS spends more on health care than any other countryResources fixed:moved from other areas: defense,education etc.Hurts American businesses, especially small companies - can’t compete in global market
20 ISSUES IN HEALTH CARE Access more likely to develop health problemspoorer outcomesVulnerable Populations -Poor -Homeless -Abused -Substance Dependent -Elderly -Immigrant-Mentally IllProper assessment requires non-judgmental and culturally competent attitudes. Critical thinking!Access: ability to pay & geographic location of facilitiesVulnerable:Those who are more likely to develop health problems as a result of excess risks ( adolescent pregnancy), who have limits in access to health care services (poor, homeless, new immigrants), or who are dependent on others for care ( older adults).Poorer Outcomes: higher mortality rates, shorter life spans