N402 Final

Population- Clinical populations

Patients who are receiving care at a specific clinic or health system. The term "population health management" is sometimes used to refer to efforts to analyze data for a specific clinical population to improve its care.

Socioeconomic status (SES)

Socioeconomic status (SES) refers to a combination of social factors that determine access to resources and power in society, including income, level of education, and occupation. Socioeconomic is a strong predictor of health outcomes.

SAVE Act

*Medicaid Expansion & Full Practice Authority for APRNs*

Goal of health equity

*The goal of achieving the highest level of health for all people regardless of differences in social, economic or environmental conditions.* Whereas equality focuses on trying to ensure everyone gets the exact same thing, equity is about fairness, and making sure people get access to the same opportunities. Health Equity focuses on looking at the different determinants that can affect an individual's health overall, and finding ways to help put them back on a level playing field with those around them.

Who are vulnerable populations?

-Racial and ethnic minorities - Uninsured and underinsured -Low income children -Frail older adults -Mentally disabled -Homeless - Physically disabled - rural Americans - Immigrants/migrant farmers - People with HIV/AIDS

Effects of SES (4)

-Shorter life expectancies -Higher rates of chronic conditions such as heart disease, stroke, diabetes, and chronic kidney disease -Poorer dental health and higher rates of loss of teeth -Poorer mental health, with higher rates of symptoms of depression and anxiety

Core Functions of Public Health

1. Assessment 2. Policy Development 3. Assurance

Key global health issues

1. Human trafficking 2. Maternal- newborn health 3. Nurses and health inequities 4. Maldistribution of the healthcare workforce 5. Emerging infectious disease

17 SDG's

1. No poverty 2. Zero Hunger 3. good health and well being 4. Quality education 5. Gender equality 6. Clean water and sanitation 7. affordable and clean energy 8. Decent work and economic growth 9. Industry, innovation, and infrastructure 10. Reduced inequalities 11. Sustainable cities & Communities 12. Responsible consumption and production 13. Climate action 14. Life below water 15. Life on land 16. Peace, justice, and strong institutions 17. Partnerships for the goals

Triple Aim

1. enhancing the patient experience 2. Improving population health 3. reducing costs

SDG's have taken a huge rebound due to Covid-19. Almost all countries have introduced new short-term social protection measures in response to the COVID-19 crisis to protect people's health, jobs and income. As these measures continue, it will impact which SDG Goal? A. Poverty B. Gender Equality C. Sustainable Cities and Communities D. Decent Work and Economic Growth

A. poverty

The County Health Rankings & Roadmaps will help you learn how healthy your community is by simply entering the: A. Zipcode B. County and area code C. Country D. state

A. zipcode

Policy Development

A core function of public health that include creating guidelines , laws and rules to improve o protect the public's health. EXAMPLE: Using morbidity data to validate the need for additional funding for public health programs in one school district.

Assurance

A core function of public health, designed to ensure that quality services are available to the public. EXAMPLE: Providing licensure to RNs assures the public of a safe workforce

Health care disparities

A distinction can be made between disparities in health outcomes (as defined above) and disparities in health care, which often result in differences in health outcomes. Health care disparities can refer to both to disparities in access to healthcare and or differences in the way individuals in different groups are treated within the health care system.

Quadruple Aim

Adding the goal of improving the work life of health care providers, including clinicians and staff. 1. Improving population health 2. Reducing cost of care 3. Enhancing the patient experience 4. *Improving provide satisfaction*

How many states have opted to participate in Medicaid expansion A. 39 B. 28 C. 42 D. 18

A. 39

What part of the PDSA would you consider adapt, adopt, or abandon? A. Act B. Plan C. Study D. Do

A. Act

Sweden has a universal health care system which is based off 3 principles except which? A. Birth-right to Care B. Cost-effectiveness C. Human Dignity D. Need and Solidarity

A. Birth-right to care

Health care systems must design improvement efforts to reduce cost - not just create better quality. One of the best ways is to reduce cost while improving care is to: A. Collaborate and with community resources. B. Demonstrate cost reduction through return on investment (ROI). C. Seek federal or private grant funding. D. Develop a one-page business plan.

A. Collaborate and with community resources

According to Hammer et al, (2019), vulnerabilities may lead to A. Disease in an individual and outbreak in a population B. Fewer poor health outcomes due to increase exposure C. Decreased mitigation in the poor and underserved D. Decrease in outbreaks related to infectious agents

A. Disease in an individual and outbreak in population

Health equality is not health equity. Health equity focuses on: A. Fairness and making sure everyone get access to the same opportunities B. Ensuring that everyone get exact same thing C. Presence of systematic disparities in healthcare D. Ignoring social determinants of health to achieve highest goals

A. Fairness and making sure everyone get access to the same opportunities

What is the difference in global health and international health? A. Global health's goal is to achieve health and health equity worldwide. International health's focus is developing countries and foreign aid. B. Global health focuses only on diseases infectious diseases that affect globally. International health focuses on all diseases. C. Global health understands that there is underlying factors causing health issues in specific populations. International health understands that planning for possible health issues is key in prevention. D. Global and international health are interchangeable terminology when referring to global health in nursing

A. Global health's goal is to achieve health and health equity worldwide. International health's focus is developing countries and foreign aid.

Which of the following is true about the affordable care act: A. it moved healthcare from a fee for service model to one that looks at health outcomes B. It required everyone to have universal health care C. Health interventions receive priority reimbursement over health promotion activities D. Payment models now focus on treatment rather than prevention

A. It moved healthcare from a fee for service model to one that looks at health outcomes

What best describes the "poverty-obesity-paradox"? A. Lower income household have higher rates of obesity B. There is an over abundance of inexpensive food calories in developed economies C. Higher income households have higher rates of obesity D. There is no correlation between the poverty and obesity in developing countries

A. Lower income (<45k) households have higher rates of obesity

Redlining decisions of the 1930's is discussed as affecting present-day in terms of pre-term births and has been deemed a social determinant of health per the article under bad policy. Which public health implication policy based on the article, needs to be reviewed? A. Policies for fair housing, economic development, and health equity should consider historical redlining's impacts on present-day residential segregation and health outcomes. B. Rules about family sizes in heavily populated areas of the country. C. Laws regarding the purchase of land and healthcare providers in those areas. D. Policies for environmental health with water treatments, food supply and transportation hazards for surrounding homes.

A. Policies for fair housing, economic development, and health equity should consider historical redlining's impacts on present-day residential segregation and health outcomes.

A public health nurse working at the Department of Health, is working with a team in developing local health policy. The nurse recognizes which of the following about policy development? A. Policy is like the Nursing Process B. Policy is up to politicians for healthcare C. Policy is to be approved by American Nurses Association D. Policy is based on the Socratic Method

A. Policy is like the nursing process

Another way to think about the goal of the Quadruple Aim is to improve health care value. You can improve value by either increasing quality or decreasing costs. Which of the following is an equation of value? A. Value = Quality / Cost B. Value = Access + Care - Cost C. Value = Care + Cost D. Value = Quality / Care

A. Value= Quality / Cost

Health concerns such as the SDG's are part of the global health call to nurses. A nurse goes into a country such as Moldova to learn their culture impact on health, person, family and community. This concept is known as? A. Cultural competence B. Humanitarian service C. Evidence based practice D. Key global issues

A. cultural competence

Sustainable Development Goals (SDG)

An urgent call for action by all countries - developed and developing - in a global partnership. They recognize that ending poverty and other deprivations must go hand-in-hand with strategies that improve health and education, reduce inequality, and spur economic growth - all while tackling climate change and working to preserve our oceans and forests.

Roe v. Wade is a modern day health concern for women and has evolved into a global cry for women's rights over their bodies and choices. However, this issue stemmed when? A. 1953 B. 1973 C. 2018 D. 2003

B. 1973

Representative Adcock gave a great wealth of information. She spoke of a well known concept in healthcare known as EMTALA. Which of the following patients is covered under EMTALA? A. 10 year old female with insurance who was brought in by the neighbor for what the child describes as human trafficking. B. 35 year old immigrant male who hurt themselves at work using a skill saw and is currently bleeding with a detatched hand. Has no insurance or idea what is happening. C. 80 year old patient who comes in to your ER with no insurance claiming that they came in contact with syphilis positive person and is covered by EMTALA to receive treatment. D. An uninsured couple who speak a foreign language and refuses to use the language line come in yelling. Because they have no interpreters on the language line to meet their needs,

B. 35 year old immigrant male who hurt themselves at work using a skill saw and is currently bleeding with a detatched hand. Has no insurance or idea what is happening.

When increasing the number of patients or events from 1 PDSA to the next, increase in multiple of: A. 2 B. 5 C. 10 D. 20

B. 5

The article "Catalysts for Change: Harnessing the Power of Nurses to Build Population Health in the 21st Century", by RWJF talks about the aging U.S. population 65 and older increasing from 46 million to 98 million by 2060. (That is OVER double!!) What does this mean in terms of nursing for nurse retirement being 1 million RN's between now and 2030? A. An excess of population health social disparities B. A tremendous loss of knowledge and experience in the nursing workforce at a time of high demand C. Healthcare reverting to preventive health vs primary care D. Healthcare chronic diseases to rise due to a staffing shortage in hospitals around the world

B. A tremendous loss of knowledge and experience in the nursing workforce at a time of high demand

Self interest or self-serving bias that influence decision making can be minimized b A. Counting the impact of the outcomes B. Being objective C. Denying the conflict of interest

B. Being objective

You are working in a primary care office and have created a quality improvement project to reduce the steps in the care process for patients, thus decreasing patient time in the office. Which of the 5 cause and effect categories are you trying to solve? A. Materials B. Methods C. Environment D. Equipment E. People

B. Methods

Financial management to include, government policies, purchasing contracts, or market mechanisms are essential to successfully reaching Triple Aim goals because they: A. Require audits before future interventions can be implemented B. Place a cap on total spending C. can bridge the cost vs supply demand D. add elements of cost and market fluctuation

B. Place a cap on total spending

The four steps for testing a change are: A. innovation-pilot-study- act B. Plan-do-study-act C. Innovate-create-implement-partake D. Plan it- make it- build it- do it

B. Plan-do-study-act

Which of the following is an essential component of systems thinking included in Deming's System of Profound Knowledge? A. Anthropology B. Psychology C. Biology D. Physics

B. Psychology

The goal of data is to show improvement efforts. The most important method to demonstrate results over time is what? A. Balancing measures B. Run Chart C. Checks and balances D. quality management

B. Run chart

When the quadruple aim is not addressed, positive patient outcomes are at risk. To maintain the triple aim and prevent negative outcomes, A. increase compensation for the increase in provider care time B. The provider and patient must have a reciprocal relationship C. Changes are needed in societies expectations and provider care capacities D. The provider must practice work life balance

B. The provider and patient must have a reciprocal relationship

This type of diagram, also known as the _____, is an improvement strategy using case and effect to solving materials, methods, environment, equipment, and people issues A. Trees B. Fishbone C. Root D. Spaghetti

B. fishbone

Socioeconomic and environmental determinants of health such as, income/wealth, employment/occupation, family and social support, and others influence individual factors, such as behavioral and physiological factors, spirituality, and resilience. These socioeconomic and environmental factors are called: A. Process of resilience B. Upstream factor C. Downstream factor D. Grit factor

B. upstream factor

Population health is defined as: A. A state of complete physical, mental, and social well being, and not merely the absence of disease or infirmity B. Our ability to interact and form meaningful relationship with others C. the health outcomes of a group of individuals, including the distribution of such outcomes within the group D. the quality care of population at a reduced cost and clinical satisfaction

C. the health outcome of a group of individuals, including the distribution of such outcomes within the group

Dr. Van Riper explained pediatric care services included free dental care and access to pediatric services until what age? A. 18 B. 13 C. 15 D. 20

C. 15

________________ from multiple healthcare providers, laboratory and test result within the medical records make all population health functions possible. A. Program measurements B. Population identifiers C. Data integration D. Population stratification

C. Data integration

You are working on med/surg hospital unit. Once a month your unit as a mandatory educational class. You notice that a colleague and friend is always late and has been written up for tardiness. He is at risk of losing his job. He texted you that he is on his way and to save a seat for him. You sign him into the class as present and on time. What category of rationalizing are you using for this unethical conduct? A. Appeal to higher loyalties B. Denial of injury C. Denial of responsibility D. Social wedging

C. Denial of responsibility

Pay for performance in optional but goodie video, explained that the idea is that providers would be paid by performance for obtaining achievable goals. Which of the following is NOT a proper pay for performance goal? A. Proving certain number of patients with preventative healthcare B. A certain percentage of patients have properly managed chronic disease C. Ensuring all patients who visit provider receive preventative medication such as aspirin to avoid bad outcomes D. A certain number of patients avoiding bad outcomes such as frequent ER visits

C. Ensuring all patients who visit provider receive preventative medication such as aspirin to avoid bad outcomes

Which of the following is a basic principle of improvement? A. Data should always drive improvement. B. When examining a complex system, consider all the parts separately. C. Every system is perfectly designed to get the results it gets. D. Improvement must come from the bottom up — not the top down.

C. Every system is perfectly designed to get the results it gets

Who was a staunch supporter of medicaid expansion and NC care 360 in inspire? A. Barack Obama B. Gale Adcock C. Mandy Cohen D. Roy Copper

C. Mandy Cohen

The nurse working at ABC clinic in rural NC is tasked to gather and analyze statin medication compliance within their diabetic patients. This would be an example of: A. Population health B. Avoidance of medication errors C. Population health management D. Infusing the triple aim into practice

C. Population health management

The UNC Malawi team focuses on which of the following? A. Nursing practice, workforce and care B. Evidence-based research, clinical care and education C. Research, capacity building and care D. Interprofessional relationships, health and education

C. Research, capacity building and care

Of the four main factors that determine the health of a population, which has the greatest impact on health? A. Clinical care B. Cost of care C. Social and economic factors D. Health behaviors

C. Social and economic factors

The 6 QSEN competencies reviewed in Inspire include all of the following EXCEPT: A. Patient- Centered Care B. Evidence-Based Practice C. Social Determinants of Health D. Quality Improvement

C. Social determinants of health

Which is not an indicator used to develop community health profiles? A. Health status B. Functional status C. Chronic disease management D. Quality of life

C. chronic disease management

According to the third SDG, Covid-19 could stall or reverse the grand progress made over the last decade to which of the following? A. global health, population health, local health. B. communicable disease, reproductive health, human trafficking. C. reproductive health, maternal health, child health. D. immunizations, infectious disease, international disease.

C. reproductive health, maternal health, child health

One of the criticisms of the ACA is that it is expensive (938 billion over 10 years!)... Which of the following is true? A. This will add to overall deficit (over 7 trillion) B. Most of this funding will come from individual pockets rather than medicare C. This expense is currently on 2% of our overall budget and 3% off what we currently spend in healthcare D. Due to the cost, states are allowed to opt out of medicaid expansion

C. this expense is currently on 2% of our overall budget and 3% off what we currently spend in healthcare

Which of the following is NOT considered to be one of the 17 SDG's? A. Climate Action B. Quality Education C. Peace, Justice and Strong Institutions D. Paris Agreement

D. Paris agreement

The NCQA evaluates population health management program using a seven prong conceptual model with _______ in the center A. community B. providers C. Cost D. People

D. People

Roe v. Wade

Overturned by supreme court; therefore states have the right to decide abortion rights *In NC, the governor signed an executive order that will direct state agencies to take measures to prevent the prosecution of people seeking reproductive health services in North Carolina.

Gale Adcock spoke about how the current system works with APRN's and Physicians. Currently APRN's must work under supervision and must have written documentation every 6 months of this in case of audits. How long must they keep this information for in-case of said audit? A. 3 years B. 1 year C. 10 years D. 5 years

D. 5 years

Distinctive characteristics of the General Model of Vulnerability include A. It is comprehensive including individual and community level risks B. Attributes of vulnerability for the total population rather focusing on sub-population C. Emphasis on convergence of risks that have additive or multiplicative impacts of health D. All of the above

D. All of the above

Which of the following is an example of shared decision making? A. An interprofessional team meet to contemplate a patient's diagnosis. B. A nurse sternly telling a patient that she needs to do a better job exercising and logging her food. C. A nurse, physician, and social worker meet to discuss a patient's plan of care. D. An obese patient and her primary care provider discuss the best treatment options.

D. An obese patient and her primary care provider discuss the best treatment options

The aim statement: A. Answers "how good, by when, and for whom B. Answer the 1st model for improvement what are we trying to accomplish C. Neither A or B D. Both A and B

D. Both A and B

If you need to measure data that is not currently being tracked, it is essential that you have a: A. Responsible party B. Inclusion and exclusion list C. Electronic medical record access D. Data collection plan

D. Data collection plan

A doctors office see's 20 patients a day and has 15 minute appointment slots with poor outcomes. The FNP saw 14 patients the same day but seems to have better health outcomes. What is the doctor's office practicing? A. Triple Aim B. Value vs Volume C. Patient Centered Care D. Fee for Service

D. Fee for service

Sexual exploitation and forced modern day slavery is recognized as a global public health problem. It is the second largest, and fastest growing, organized crime trade in the world with an estimated financial gain of $44 billion annually! What is concept known as? A. Social Inequities B. Prostitution C. Epstein Island D. Human Trafficking

D. Human trafficking

CMS has a goal of having 90% of all medicare payments being tied to quality outcomes. When was this goal achieved? A. 2018 B. 2022 C. 2009 D. It has not been achieved

D. It has not been achieved

The concept of behavioral ethics has 4 components: Moral awareness, Moral decision making, Moral intent, and Moral action. Moral myopia or ethical fading, which can blind us from ethical miscues is typically found is which component of behavioral ethics? A. Moral action B. Moral decision making C. Moral intent D. Moral awareness

D. Moral awareness

Vulnerable populations are at higher risk of poor health outcomes as a result of Social, economic, political and environmental resources and those with illness and disability. Which of the below populations are considered vulnerable for poor health outcomes? A. Suburban females who do not work outside the home B. All third grade students in NC C. College campus freshmen in the UNC system D. Native Americans and American Indians

D. Native Americans/American Indians

In a fee for service model: A. Incentivized being based on outcomes B. Is focused on providing the right care at the right rime C. Has been shown to have more focus on high risk patients D. Organizations have incentives to do more (Offer more tests, serve more patients, and make more referrals)

D. Organizations have incentives to do more (Offer more tests, serve more patients, and make more referrals)

That three things does it require to turn moral intent into moral action? A. Self determination, equality, visionary B. Buy ins, choices, ownership C. Myopia, choices, and courage D. Ownership, efficacy courage

D. Ownership, efficacy, and courage

The complete "life cycle" of an improvement project contains several distinct phases: A. Improvement using pilot strategy to establish a plan B. Assess- plan- diagnose- implement- evaluate C. Complete a needs assessment to refine and evaluate D. Set an Aim, develop an improvement strategy, develop and pilot a reliable standard process of care, implement the standard care process, monitor performance, spread the new standard though out the system

D. Set an Aim, develop an improvement strategy, develop and pilot a reliable standard process of care, implement the standard care process, monitor performance, spread the new standard though out the system

Principles of health policy are important in that the effect of population health policy, must remember exercise of rights, duties, or privileges associated with outcomes. What must also be considered? A. Our politicians, representatives, and speakers. B. Our situations, and circumstances, of public health. C. The community, individuals, and global issues. D. The status, and effect, of social determinants of health.

D. The status, and effect, of social determinants of health

Wayward, yet not illegal, psychological, organizational, and/or social influences cause us to make A. Beneficial decisions B. Rational decisions C. Emotional decisions D. Unethical decisions

D. Unethical decisions

Which is a key global health issue? A. Global initiatives B. Chronic disease management C. Emerging derivatives D. Maternal-newborn health

D. maternal newborn health

Population Health

Defined as "the health outcomes of a group of individuals, including the distribution of such outcomes within the group," -key driver of value-based care success. -Organizations that can deliver population health have more positive outcomes that in turn results in an effective value-based care model

Population- Broad communities

Defined by place of residence or demographics, regardless of whether they are accessing healthcare services.

Principle 5

Determination of the effect of population health policy, insofar as it creates or does not impede the exercise of rights, duties, or privileges associated with outcomes, must also take into account the status, and effect, of social determinants of health

Health disparities

Differences in length and quality of life and rates and severity of disease and disability because of social position, race, ethnicity, gender, sexual orientation, education, or other factors

Principle 1

Directives, plans, and courses of action that may be required by law or developed in compliance thereto, or proffered voluntarily, documented in written instruments or manifest in norms and behaviors sanctioned through customary practice without objection.

As of 2022, NC has opted to participate in Medicaid expansion

False

In global settings, geography is a major driver to access to healthcare and these urban-rural disparities tend to have great quality care clinics and lead to great patient outcomes.

False

The difference in population health and public health is that population health focuses on community-based approach defined by country, state, county or specific community and public health involves planning, delivering, and evaluating various interventions in increasing efforts to achieve better outcomes in the population of interest.

False

Value Based care

Governmental and non-governmental payers are increasingly linking reimbursement to quality outcomes as opposed to the number of services.

Moving from the ACA to the value based model

Health care professionals are now reimbursed for the improvements that they make, rather than a simple fee-for-service model.

Health equity

Health equity refers to the absence of systematic disparities in health (or in the major social determinants of health) between groups with different social advantage/disadvantage (i.e., wealth, power, prestige) Health inequity refers to the presence of such differences, disparities in health (or health care) that are systemic and avoidable and, therefore, considered unfair or unjust

Assessment

Includes a systematic, objective process of gathering and analyzing health data and making the information available to the public. EXAMPLE: Gathering information to determine if evacuation routes are safe to travel on, after a hurricane

Affordable care act

Intended to increase access to health care, to give patients the flexibility to make informed decisions about their health, and to change payment models in ways that encourage prevention and cost-effective care.

Global Health

It embraces a complex concept that engages with all countries and indeed with the health of the planet itself. Issues require complex interprofessional and interagency cooperation and solutions that involve governments, non-profits, and many times, include private companies and foundations.

Principle 2

Population health policy prioritizes early detection, treatment, and mitigation of, and rehabilitation following, disease among at-risk and symptomatic individuals.

Global cooperation

Response, planning, prevention, preparedness, and care that reflects health equity issues among nations. The Covid-19 pandemic was a perfect example of this in recent times. There are other diseases such as smallpox currently being an outbreak or even considering Ebola as another infectious disease.

Principle 3

The development of population health policy is the product of political, economic, epidemiological, ethical, behavioral, and legal considerations and their co-variations.

Principle 6

The evaluation of population health policy includes both normative and empirical inquiries that may be applied to all of its component considerations and their co-variations.

Principle 4

The heterogeneity of population health needs among groups of individuals across different demographics and jurisdictions requires the development of population health policy that balances the standardization and customization of interventions.

Principle 7

The management of population health requires alignment between organizational strategic planning and the strategic management of human resources, with the population health needs identified through available health needs assessments and input from affected population members.

7 Foundational principles

These principles are meant to empower stakeholders—whether it is the planner or the practitioner, the decision maker or the dedicated caregiver—and inform the development of practical tools, research, and education.

According to Dr. Kenya Beard in Inspire, she explained that the original thought in the 80's of why patients could not achieve highest level of health, was because patients were not doing what providers instructed them to do vs looking at social determinants of health.

True

Baseline data is data collected before the improvement effort, so that you know how you're doing before you begin testing changes

True

Classifying and separating data according to specific variables to help inform decisions about what changes to make is called stratification

True

Dr. Villegas Rodriguez explained that under the Spain Constitution has health guarantees that include: covered is prevention, diagnosis, treatment and monitoring.

True

House Bill 227 & Senate Bill 249 includes Medicaid Expansion & Full Practice Authority for APRNs, which has passed its way from the Senate and is the first time in history that full practice authority has advanced from the floor

True

Moral decision making is having ability to decide which is the right course of action once the ethical issues is recognized

True

The infographic assignment is a one page document. Your audience can be a healthcare administrator, policy maker, or fellow nurse, but you must identify who you are speaking to in the infographic.

True

Thinking globally enriches perspective, increases knowledge and makes nurses more motivated and effective leaders, practitioners, managers, teachers, researchers, policy-makers and activists.

True

While not all changes lead to improvement, all improvement requires change

True

Patient engagement

it can provide an assessment of their risk and protective factors against disease and other health outcomes. Understanding the impact of diversity on health outcomes is a COMPLEX process, but is essential to quality care. You also need to recognize any barriers that might also impact these outcomes. Patients report that their provider does not listen and appears to rushed. They feel undervalued in their care and have a poor understanding of their disease trajectory. There is a mismatch between provider and patient goals

Degree of belief in the change is, how likely you believe the change is to lead to improvement

true