Chapter 8 objectives

Problem (NANDA label) Etiology (r/t: related factors) Symptoms (defining characteristics/AEB)

3 Part Diagnostic Statement: PES

AHRQ: (Agency for Healthcare Research and Quality) Their mission is to produce evidence, to make health care safer, higher quality, more accessible, equitable and affordable, and to work within the U.S. Department of Health and Human Services and with other partners to make sure that the evidence is understood and used. PCMH: (Patient Centered Medical Home) AHRQ definition: comprehensive care, patient-centered/coordinated care, accessible services, quality and safety

Compare and contrast settings and agencies that provide health care.

-Originated from PPACA (patient protection and the affordable care act). -Provide incentives for doing well coordinated, integrated care instead of high volume of services. -Made up of hospitals, primary care settings, specialty care practices. Only one bill for all services received across all settings.

Compare and contrast these health care delivery systems: accountable care organizations

-Regionalized services for vulnerable communities, emphasis on primary care and education. -Goal is for everyone to have access to care regardless of ability to pay. -Mary Breckenridge's clinic in rural KY was the first of its kind. -Nurses provide primary care.

Compare and contrast these health care delivery systems: community health centers

-Enhanced primary care model providing coordinated, comprehensive, whole-person care. -1960s, by American Academy of Pediatrics, became common in 2007 under PCMH (patient-centered _______ _____) view. -Advancement of nursing homes, raising standards since 2012.

Compare and contrast these health care delivery systems: medical homes

Agency for Healthcare Research and Quality (AHRQ) defines a ________ ______________ as: -a PCMH, and other clinicians, providing care for patients within the nursing home as well as community and service organizations as well as state and local public health agencies. -Focusing on individual patient care while also incorporating community health needs as well as aspects of population health.

Compare and contrast these health care delivery systems: medical neighborhoods

-Late 1800s, Mayo Clinic founded in Rochester, MN. -Physicians of different specialties came together and shared income, expenses, facilities, ect. To provide better, more comprehensive care -Serve specific communities

Compare and contrast these health care delivery systems: multispecialty practice groups

Until recently, physicians were private/solo and had fee-for-service practice Most hospitals were not-for-profit, and physicians held a lot of power over hospitals because they were not employees Physicians had a lot of power because hospitals depended on physicians to admit patients or refer them for treatment The fee-for-service arrangement caused financial incentive for physicians doing more care, not necessarily better care

Compare and contrast these health care delivery systems: physicians and hospitals

-Either no fee or co-payment required. -Goal of primary care is reducing costs by preventing illness. Popular with managed care of large employers. -HMOs (health maintenance organizations) allow subscribers to receive medical services required through a group of affiliated providers. -PPOs (preferred provider organizations), allow third party payer (insurance company) to work with a group of providers to provide cheaper services in return for prompt payment and guaranteed patient volumes

Compare and contrast these health care delivery systems: prepaid group practices

Establish a national focus Identifying and learning from errors Raising performance standards and expectations Implementing safety systems in health care organizations pay for performance penalties for excess readmissions

Describe strategies to increase access to affordable, high-quality care.

Assessment Diagnosis Outcome Identification and Planning Implementing(the interventions) Evaluation

Describe the phases of the nursing process and Standards of Care set by the ANA

Changes taking place in health care give nurses the opportunity to help shape healthcare for the future

Describe the role of nursing in meeting the challenges of health care reform.

Nurses are becoming a stronger voice in addressing health related problems in our nation and proposing solutions

Describe the role of nursing in meeting the challenges of health care reform.

Nurses in greater numbers are increasing their education and becoming APRNs

Describe the role of nursing in meeting the challenges of health care reform.

The focus of nursing care provided by all nurses is holistic care essential to promoting health and preventing illness

Describe the role of nursing in meeting the challenges of health care reform.

Changing demographics Increasing diversity Technology explosion Globalization of economy and society Educated and engaged consumers Increasing complexity of care Costs of health care Effects of health policy and regulation Shortages of key health care professionals and educators

Discuss selected trends and issues affecting healthcare delivery.

Actual Nursing Diagnosis: describes human responses to health conditions/life processes that exist in an individual, family, or community Risk for Nursing Diagnosis: describes human responses that MAY develop in a vulnerable person, family, or community; The plan is aimed at preventing the problem

Discuss the classification of nursing diagnosis

Out-of-pocket payment Individual private insurance employer -based private insurance Government financing: Medicare - DRGs (diagnosis-related groups are payment plans that are based on patient classification categories) 65 and older Medicaid - People with very low income for people of any age Current budget considerations are to trim Medicaid expenditures by reducing benefits or placing patients into managed care programs.

Evaluate four basic ways in which health care is paid for.

Safe Effective Patient Centered Timely Equitable

Identify elements of a well-functioning health care delivery system

Physician, physician assistant Nurse; unlicensed assistive personnel Physical, occupational, and respiratory therapist Dietician Speech Pathologist Social Worker Pharmacist Chaplain/ spiritual care provider

Identify the members of the interdisciplinary healthcare team.