healthcare final exam

The population of older Americans in need of LTSS is projected to A. Increase B. Decrease C. Stay the same D. Stay the same after 2040

A. Increase

Which is not one of the three phases of medical practice redesign according to Kilo and Wasson? A. Basic investigation B. Model development C. Analysis D. Dissemination

C. Analysis

How did the AMA react to proposals for compulsory national health insurance during the Great Depression? A. They supported it B. They supported it but were concerned about its feasibility C. They actively opposed it D. They had no opinion

C. They actively opposed it

International medical graduates make up _____ of the primary care physician workforce A. 25% B. 30% C. 45% D. 60%

A. 25%

What percentage of older Americans obtain long-term care insurance? A. About 7.5% B. About 15.5% C. About 30% D. About 50%

A. About 7.5%

In which phase of medical practice redesign were computers first used to improve clinical practice? A. Basic investigation B. Model development C. Analysis D. Dissemination

A. Basic investigation

Under President Clinton which piece of legislation was enacted? A. CHIP B. The Health Security Act C. The National Health Care Reform Act D. The Affordable Care Act

A. CHIP

What was the main argument Ezekiel Emanuel made in the NYT article "Are Hospitals Becoming Obsolete?" A. Care is being shifted out of hospitals into cheaper, more effective settings B. The only thing preventing hospitals from becoming obsolete are Washington lobbyists C. The consolidation of hospitals is a detrimental trend that will cause healthcare inequalities D. A and B

A. Care is being shifted out of hospitals into cheaper, more effective settings

Which of the following medical professionals do not prescribe drugs or perform surgery? A. Chiropractors B. Osteopaths C. Obstetricians D. Podiatrists

A. Chiropractors

The ____________ model highlights the importance of continuous care and the development of self-management skills for patients. A. Chronic Care B. Continuous Spectrum Care C. Clinical Microsystems D. Affordable Care Act

A. Chronic Care

The Dartmouth Atlas brief data shows that overall Medicare hospital use in the last six months of life has _______ while Medicare spending at the end of life has __________ A. Decreased; Increased B. Increased; also increased C. Increased; Decreased D. Remained the same; Increased

A. Decreased; Increased

When did universal health care coverage first become a policy issue in the United States? A. During the progressive era (1890s-1920s) B. After World War I (1914-1918) C. During the Great Depression (1929-1941) D. After the cold war (1945-1989)

A. During the progressive era (1890s-1920s)

Which of the following is not a convenient care option for low-acuity conditions? A. Emergency room B. Urgent care clinic C. Minute Clinic D. Patient telephone call

A. Emergency room

The percentage of active primary care generalist physicians A. Has decreased since 1949 B. Has increased since 1949 C. Has remained steady since 1949 D. Is unknown (this number has only been tracked since 1970)

A. Has decreased since 1949

Countries whose health systems are oriented more toward primary care achieve A. Higher satisfaction with health services among their populations B. Higher expenditures in the overall delivery of care C. Increased ED visits D. Increased hospitalization rates

A. Higher satisfaction with health services among their populations

How has the ER changed in the past 50 years? A. Increased ability to treat a wider-range of health problems B. More widespread use of community physicians C. Ambulances became slower D. Fewer patients with chronic conditions

A. Increased ability to treat a wider-range of health problems

Why is the closing of hospitals in rural areas particularly problematic? A. Increased travel time for patients urgently in need of medical care B. Consolidation results in higher malpractice premiums C. More children live in these areas D. All of the above

A. Increased travel time for patients urgently in need of medical care

What is one of the barriers to hospice enrollment? A. Late referrals B. Low cost C. Wide-range of palliative care specialists D. General perception that seriously ill patients don't need hospice

A. Late referrals

Convenient care options mainly provide care for: A. Low-acuity conditions B. High-acuity conditions C. Athletes D. Medicare patients

A. Low-acuity conditions

What is the main goal of long-term care? A. Maintain function and prevent further decline B. Return a person to independent living C. Reverse the decline in activities of daily living D. Cope with multiple chronic conditions

A. Maintain function and prevent further decline

The most prominent reason for the decline in the number of procedures performed in hospitals is A. Most of these procedures were shifted to the outpatient setting B. Most of these procedures were deemed outdated C. Most of these procedures were unsafe D. Most of these procedures used technology that was too expensive

A. Most of these procedures were shifted to the outpatient setting

In a patient-team partnership A. Physicians and patients make shared decisions about diagnosis and treatment B. Patients and their families communicate with nurses only C. Physicians and patients both contribute to the cost of healthcare D. Patients and their significant others take turns attending doctor visits

A. Physicians and patients make shared decisions about diagnosis and treatment

What does the Disproportionate Share Hospital program do? A. Provides federal funds to compensate hospitals for caring for the uninsured B. Provides state funds to compensate hospitals for caring for the uninsured C. It is a charity program that compensates hospitals for caring for low-income patients D. It is a federally funded program that provides funds to build hospitals in low-income areas

A. Provides federal funds to compensate hospitals for caring for the uninsured

Primary care A. Provides initial diagnosis B. Is limited to illness episodes C. Is focused and intense D. Treats only comorbidities

A. Provides initial diagnosis

Which of the following describes recent trends in retail clinic visits? A. Retail clinic visits have increased substantially B. Retail clinic visits have decreased substantially C. Retail clinic visits have remained relatively stable D. Retail clinic visits have only increased in major cities

A. Retail clinic visits have increased substantially

According to Primary Care: Current Problems and Proposed Solutions, which of the following might solve the issue of difficulty with accessing primary care physicians? A. Same day scheduling B. Subsidizing prescription drugs C. Discounts on primary care for older/sicker citizens D. More medical devices

A. Same day scheduling

In the Gawande article entitled The Heroism of Incremental Care, which medical problem plagued Bill Haynes for nearly forty years? A. Severe chronic migraines B. Cancer C. Hypertension D. Diabetes

A. Severe chronic migraines

Which of the following is a typical setting for ambulatory care services? A. Sports medicine clinics B. Firehouse C. Dialysis centers D. Rehabilitation hospitals

A. Sports medicine clinics

In the KHN article by Blau, which piece of government legislation enabled international student Garcia Manrique to attend medical school? A. The Deferred Action for Childhood Arrivals Program (DACA) B. The Affordable Care Act C. Congressional Review Act D. The Social Security Act

A. The Deferred Action for Childhood Arrivals Program (DACA)

Which of the following demonstrates the movement in nursing homes, referred to as "culture change"? A. The environment promotes physical and psychological well-being B. Older adults from all different backgrounds are being accepted as residents C. Nurses have different attitudes towards the residents to help them feel accepted D. Residents treat other residents like family members so the environment feels more like a home

A. The environment promotes physical and psychological well-being

"Twitter Tailwinds" tells stories which highlight A. The increasing importance of social media in medical treatments B. The dissatisfaction of primary care doctors C. the upsides of the medical profession D. The rise of Twitter as the major political platform for physicians

A. The increasing importance of social media in medical treatments

What is the ultimate goal of the 10 building blocks of high-performing primary care? A. To achieve "the template of the future" (patients have a variety of ways to access their physician, physicians have fewer and longer visits, practices efficiently distribute tasks) B. To provide low-cost efficient care C. To automate care D. To decrease the amount of time physicians, spend with each patient

A. To achieve "the template of the future" (patients have a variety of ways to access their physician, physicians have fewer and longer visits, practices efficiently distribute tasks)

True or false: Under U.S immigration law, foreign-born doctors are required to practice in a medically underserved area for three years A. True B. False

A. True

When was the Medicare and Medicaid bill passed? A. 1940 B. 1965 C. 1990 D. 2012

B. 1965

Hospital-based transitional care units must be certified as A. An acute care hospital B. A SNF C. A NF D. Both a SNF and a NF

B. A SNF

In the delivery of long-term care, customized interventions are carried out according to A. An assessment developed by family members B. A plan of care C. Weekly evaluations by the patient's physicians D. A philosophy of total care

B. A plan of care

The number of hospitalizations has _______ since 1981 A. Increased B. Decreased C. Stayed the same D. More information is needed

B. Decreased

The number of small primary care practices is A. Increasing B. Decreasing C. Has remained virtually the same D. Constantly fluctuating

B. Decreasing

True or false: The increasing number of NPs and PAs is enough to fill the gap caused by the decreasing number of primary care physicians A. True B. False

B. False

Which of the following are major problems in primary care as outlined by Lazris, Roth, and Brownlee in Health Affairs? A. Lack of resources, cultural bias against PCPs, high medical school costs B. Lack of resources, regulatory burden, unfair/inefficient payment schemes C. Regulatory burden, high cost of living in PCP areas, lack of political will D. Regulatory burden, lack of political will, high barriers to entry

B. Lack of resources, regulatory burden, unfair/inefficient payment schemes

What is the most important reason for efficient health care delivery in Grand Junction, Colorado according to Bodenheimer and West? A. Robust end-of-life care B. Leadership by the primary care community C. Withholding payment for over-utilization of services D. Reimbursing primary care physicians at higher rates

B. Leadership by the primary care community

Those with palliative care experience ______ pain, anxiety, and family exhaustion than those without palliative care at the end of life A. More B. Less C. About the same level of D. None of the above

B. Less

Who falls into the LTSS coverage gap? A. Older Americans who qualify for Medicaid but not Medicare B. Older Americans who don't qualify for Medicaid and have moderate to severe levels of disability C. Older Americans who choose to obtain private insurance and have low levels of disability D. Older Americans whose primary caregivers are family members

B. Older Americans who don't qualify for Medicaid and have moderate to severe levels of disability

A patient with special needs could expect to receive efficient, appropriate, team-approach care from which of the following? A. Primary care B. Patient-centered medical home C. Community-oriented primary care D. Outpatient care

B. Patient-centered medical home

Which of the following describes Bodenheimer & Bauer's vision for the scope of work for primary care physicians in the future? A. Primary care doctors will become obsolete B. Primary care doctors will probably focus more on complex patients while nurses and PAs take over other primary care responsibilities C. Primary care doctors will probably work in hospitals, delivering care to high-income patients D. Primary care doctors will probably participate in more fellowships in order to obtain a specialization

B. Primary care doctors will probably focus more on complex patients while nurses and PAs take over other primary care responsibilities

Residency programs are increasingly training more A. Primary care physicians B. Specialists C. Nurse practitioners D. Rural physicians

B. Specialists

Which of the following is a concern expressed by Bodenheimer & Bauer about the increasing role of nurses in primary care? A. Nurses are generally unwilling to increase their clinical responsibilities B. Training in nursing schools is focused on inpatient care rather than primary care C. Increases in payment for nurses could bankrupt the health system D. None of the above

B. Training in nursing schools is focused on inpatient care rather than primary care

One reason women's health centers were created is: A. Women have more money than men B. Women seek care more often than men C. Women have shorter lifespans than men D. Women get sick more often than men

B. Women seek care more often than men

Based on what three medical problems does Hospital Compare rank the quality of different hospitals? A. Heart failure, musculoskeletal disorders, cancer B. Pneumonia, cancer, heart rhythm C. Acute heart attacks, heart failure, pneumonia D. Senioritis, asthma, obesity

C. Acute heart attacks, heart failure, pneumonia

RNs are poised to help fill the gap caused by primary care shortages in A. Psychiatric care management B. Pediatric care management C. Chronic care management D. Integrated care management

C. Chronic care management

The size of the primary care workforce is ______ and the number of nursing practitioners is ______. A. Increasing, Increasing B. Increasing, Decreasing C. Decreasing, Increasing D. Decreasing, Decreasing

C. Decreasing, Increasing

What is the doctors "new dilemma" as articulated by Suzanne Koven? A. Determining how to ration limited medications B. Putting patient concerns above financial gain C. Determining how to ration limited time among patients D. Battling disparities in payment between primary care physicians and specialists

C. Determining how to ration limited time among patients

Which three models gained prominence during the model development phase of medical practice redesign? A. Chronic Care Model, Clinical Microsystems, Behavioral Institutionalism B. Chronic Care Model, Clinical Microsystems, Affordable Care Act C. Idealized Design of Clinical Office Practices initiative, Chronic Care Model, Clinical Microsystems D. Idealized Design of Clinical Office Practices initiative, Clinical Microsystems, Behavioral Institutionalism

C. Idealized Design of Clinical Office Practices initiative, Chronic Care Model, Clinical Microsystems

Which is not one of the recommendations made by IOM for improving EOL care? A. All health care insurers should cover some form of palliative care B. Development of standards for advance care planning and patient communication C. Implement the use of POLST in all care settings D. All health care providers should be proficient in palliative care E. Stakeholders should engage the public and promote advanced care planning

C. Implement the use of POLST in all care settings

Recent trends in palliative care show that the number of Medicare patients enrolled in hospice have ________ and the number of hospice days per patient has ________. A. Decreased; Increased B. Increased; Decreased C. Increased; also increased D. Decreased; Remained the same

C. Increased; also increased

According to Larson and Reid, which is not a reason for the decline of primary care since the 1990s? A. Increasing demands placed on primary care physicians due to increased chronic disease B. Primary care is less financially viable than specialty care C. Increasing paperwork due to increasingly complex insurance schemes D. None of the above are reasons for the decline in primary care

C. Increasing paperwork due to increasingly complex insurance schemes

Which is the largest payer for home health services? A. Medicaid B. Out-of-pocket funds C. Medicare D. Private Insurance

C. Medicare

Basic assistance with ADLs is provided mainly by A. Physical therapists B. Licensed nurses C. Paraprofessionals D. Occupational therapists

C. Paraprofessionals

Midlevel providers (MLPs) include which of the following A. Osteopaths B. Dentists C. Physician assistants D. Registered Nurses

C. Physician assistants

What do advance directives accomplish? A. They make it easier for policymakers to set up death panels B. They reduce caregiver burden by subsidizing annual vacations and regular time off work C. They help ensure that patients goals and preferences for care at the end of life are met D. They aid caregivers in deciding which cancer treatments will work best for their loved ones

C. They help ensure that patients goals and preferences for care at the end of life are met

Expanding Medicaid... A. will increase the number of hospitals in the long-term B. causes specialists to flee from rural areas with low-income patients C. is associated with a reduction in uncompensated care costs in hospitals D. All of the above

C. is associated with a reduction in uncompensated care costs in hospitals

Regions with a _________ ratio of population to primary care practitioners are designated as Primary Care Professional Shortage Areas A. 2:1 B. 20:1 C. 200:1 D. 2000:1

D. 2000:1

According to The Heroism of Incremental Care, which of the following is an advantage of primary care? A. Having a primary care doctor increases patient willingness to seek care for severe symptoms B. Primary care doctors use an empirical "big picture" approach to solving medical problems rather than a "rule out" strategy C. Patients don't have to sit through diagnostic tests D. A & B

D. A & B

Bodenheimer's 10 building blocks of high performing primary care are based on which existing model(s) of primary care improvement? A. PCMH Recognition Standards B. ACA 10 essential health benefits C. Starfield's 4 Pillars of Primary Care D. A & C

D. A & C

In the KHN article by Blau, foreign-born physicians experienced: A. Difficulty with re-entry into the U.S B. Scrutiny at work C. More respect from their patients compared to native physicians D. A and B

D. A and B

Which of the following is true regarding recent trends in End of Life Care in the U.S? A. Most people 65+ have not discussed End of Life Care with their physicians B. Most physicians are not trained to discuss End of Life Care C. Medicare hospice use is decreasing D. A and B

D. A and B

Why is Grand Junction, Colorado considered a model in health care provision? A. The city managed to reduce per capita Medicare spending to a level that was 24% of the national average B. The city performs above the national average on various healthcare quality metrics C. The city was the first to implement Medicare and expand Medicaid D. A and B

D. A and B

Why might hospital care become obsolete according to the NYT article by Ezekiel Emanuel? A. The alarming rise of iatrogenic disease B. Better alternative settings for care C. Special interest lobbyists D. A and B

D. A and B

According to the Kellerman article entitled "The ER, 50 years and on" which is a reason for the increase in ER use? A. Inaccessibility of primary care physicians on weekends, nights, and holidays B. Increase in low-acuity conditions which require emergency care C. Public perception of the ER as a place where one can receive care at all times D. A and C

D. A and C

According to the article The Doctor's New Dilemma, taking the time to talk to patients can: A. Help control blood pressure B. Help relieve pain C. Help relieve physician burnout D. All of the above

D. All of the above

Many primary care physicians in the U.S face A. Burnout B. Feeling disillusioned with their careers C. Emotional exhaustion D. All of the above

D. All of the above

Palliative care includes: A. Management of pain and emotional distress B. Family caregiver support C. Coordinated care and services D. All of the above

D. All of the above

Regions with more access to primary care physicians have: A. Lower infant mortality B. Fewer hospitalizations C. Lower rates of general mortality D. All of the above

D. All of the above

What is a challenge to implementing the patient centered medical home? A. The decline in the number of primary care physicians B. Over-optimistic expectations about the PCMH's ability to solve healthcare problems C. Need for more patient engagement in medical care D. All of the above

D. All of the above

What were the results of the Group Health "proof of concept" investigation of the patient-centered medical home in the Larson and Reid article? A. Patient experience, clinical work experience, and quality of care were better in the PCMH B. Fewer emergency department visits were experienced in the PCMH C. Ambulatory care sensitive hospitalizations were decreased in the PCMH D. All of the above

D. All of the above

Why is the proliferation of convenient care options potentially concerning? A. They increase utilization and spending B. They decrease continuity of care C. They increase financial pressure on primary care physicians D. All of the above

D. All of the above

In the Health Affairs blog, which of the following do Lazris, Roth, and Brownlee suggest as solutions to the "crisis" in primary care? A. Political action through lobbying B. Subsidies for primary care training C. Direct primary care D. B and C

D. B and C

Which is not one of the drivers of growth in convenient care options? A. Demand for instant care (drop in visits, same-day appointments, etc.) B. Lower overhead costs of convenient care options C. Entrepreneurial spirit among convenient care providers D. Better quality care in convenient care clinics

D. Better quality care in convenient care clinics

When patients have multiple health problems, this is called A. Coaffliction B. Comortality C. Codependency D. Comorbidity

D. Comorbidity

In which phase of medical practice redesign did the concept of the medical home emerge? A. Basic investigation B. Model Development C. Analysis D. Dissemination

D. Dissemination

Which is not one of the recommendations made by Thomas and Applebaum for improving LTSS? A. Increased support and training for informal caregivers B. Additional research to expand quality measures C. Increase wages and benefits for direct care positions in LTSS D. Increase wages and benefits for geriatricians

D. Increase wages and benefits for geriatricians

Which group contributes the most to the provision of long-term care? A. Primary care physicians B. Nurses C. Physical therapists/Occupational therapists D. Informal caregivers (family/friends)

D. Informal caregivers (family/friends)

Areas with more primary care physicians experience all of the following except: A. Better medical outcomes B. Lower health care spending C. Better patient satisfaction D. More emergency department visits

D. More emergency department visits

In which of the following areas has the U.S malpractice system been successful? A. Fairly compensating patients harmed by physician/hospital negligence B. Settling cases quickly/cost effectively C. Providing an incentive for providers to reduce mistakes and improve their quality of care D. None of the above

D. None of the above

Which is not one of the reasons for Grand Junction's success in providing high-quality, low-cost health? A. Limits on the supply of expensive resources like specialists and medical equipment B. Payment of primary care physicians for hospital visits C. Robust end-of life care D. Paying primary care physicians more than private insurance

D. Paying primary care physicians more than private insurance

According to the Gawande article entitled "Quantity and Quality of Life", how do physician deaths compare with the deaths of their patients? A. Physicians experience significantly less institutional care at the end of their lives than their patients B. Physicians experience significantly greater hospice care and overall higher quality of End of Life Care C. Physicians experience significantly more institutional care at the at the end of their lives than their patients D. Physicians experience about the same level of institutional care and hospice care as their patients

D. Physicians experience about the same level of institutional care and hospice care as their patients

A long-term care facility must be certified in order to A. Operate as a nursing home B. Comply with national fire and safety codes C. Obtain deemed status D. Receive payment for Medicare and/or Medicaid patients

D. Receive payment for Medicare and/or Medicaid patients

Quality of care is ______ among NPs compared to primary care physicians and patient satisfaction is _______ among NPs compared to primary care physicians A. Higher, the same B. Lower, the same C. The same, lower D. The same; the same

D. The same; the same

The "headwinds/tailwinds asymmetry" refers to A. High speed trade winds that blow throughout North America causing seasonal illnesses B. The Hippocratic oath C. A medical bias that leads patients to trust specialists more than primary care physicians D. The tendency to focus on barriers and disadvantages

D. The tendency to focus on barriers and disadvantages

According to the Institute of Medicine, primary care is "the provision of _____, accessible health care services by clinicians who are _______ for addressing a large majority of health care needs..." A. efficient; well-compensated B. efficient; accountable C. integrated; trained D. integrated; accountable

D. integrated; accountable

True or False: All ambulatory care is primary care? True False

False

True or False: In the long-run, the ACA will reduce the need for primary care providers

False

True or False: Patients who focus on disease control rather than palliative care at the end of life live longer. True False

False

True or False: Hospital based emergency care is the only treatment to which Americans have a legal right, regardless of their ability to pay? True False

True

True or False: In a skilled nursing facility, Medicare covers only short-term rehabilitation or convalescence. True False

True

True or False: In order to receive hospice care, Medicare patients must give up curative therapy? True False

True

True or False: Recent trends show decreases in Medicare spending for EOL Care with increasing age? True False

True

True or False: There is wide variation in the quality of healthcare services across the United States

True

True or False: Typically, tertiary care is highly specialized

True

True or False: We are facing a shortage of LTSS direct care workers? True False

True