Exam 2 Review

"Hospitals can no longer live in a four-walls, brick-and-mortar world." This statement refers to which encompassing principle of healthcare reform?

-Focus on population health status with community-based care delivered in multiple provider sites

For many years, the standard for assessing hospital quality of care was peer review using physician audits of selected patient records to judge "the degree of conformity with preset standards." Which of the following was not a reason for the ineffectiveness of such audits?

-Hospital administrators influenced how reviewers were selected

The premise of the IHI is that in order to optimize the healthcare system, three objectives must be addressed simultaneously. Which of the following answers accurately describes the objectives?

-Improving the patient experience of care (including quality and satisfaction) -Improving the health of populations -Reducing the per capita cost of health care -All of these are correct.

Which of the following accurately describes academic health centers' advances in the medical sciences and technology in health care?

-Increased both the life expectancy of most Americans and the proportion of the gross national product devoted to health care

Which of the following correctly lists types of hospitals?

-Nongovernment not-for-profit community hospitals, investor-owned (for-profit) community hospitals -State and local government community hospitals, federal government hospitals, or VA hospitals -Nonfederal psychiatric hospitals, prison hospitals, college infirmaries All of these are correct.

Which of the following provide services that help restore function, improve mobility, relieve pain, and prevent or limit physical disabilities of patients suffering from injuries or disease?

-Physical therapists

In the 1990s, ambulatory care facilities of all types proliferated. Reasons for this proliferation include which of the following?

-Physician profit-making opportunities -Physician freedom from hospital facility scheduling -Consumer preferences -All of these are correct.

How do hospitals maintain American College of Graduate Medical Education accreditation?

-Program directors are responsible for maintaining their training program's accreditation. -Programs maintain extensive records documenting all trainees and their educational activities. -Programs undergo a formalized and periodic reaccreditation evaluation. -All of these are correct.

Which of the following accurately lists the multiple factors associated with lack of access to behavioral health services and care?

-Provider geographic distribution, financial limitations, lack of or inadequate health insurance -Misunderstandings about the treatability of conditions, a poorly organized care delivery system -Personal and provider attitudes, cultural issues, stigma -All of these are correct.

In today's hospitals, outpatient clinics frequently provide

-care for those without private physicians. -teaching sites for medical residents. -primary-care services organized similarly to private physician offices. All of these are correct

What inferences can you make about the Recovery Oriented Systems of Care and Integration of Primary Care and Behavioral Health Services?

They are both paradigm shifts directed toward turning the de-facto mental health system into a more integrated and effective system of care.

In health care, which of the following terms refers to a system that includes several service components with each addressing one or more dimensions of a population's healthcare needs?

Vertically integrated

Which of the following agencies recognized the need for increased services and established psychiatric hospitals and clinics?

Veterans Affairs National

Someone who plays a role in delivering health care, including individuals who provide direct patient care as well as individuals who indirectly support patient and healthcare delivery, best describes:

a healthcare professional.

Advanced practice registered nurses (APRNs), a type of mid-level provider or physician extender, are nurses who have education and experience beyond the requirements of an RN. It is generally accepted that nurse practitioners should be registered nurses with:

a master's degree.

Maintenance of certification (MOC) is all of the following except

a requirement by most states to maintain licensure to practice in a state.

Early on, hospitals used information technology (IT) primarily for

accounting and billing purposes

A supervised program of social activities and custodial care (social model), medical and rehabilitative care through skilled nursing (medical model), or specialized services for patients with Alzheimer's disease or other forms of dementia describes

adult day care

Long term care for individuals who do not require skilled nursing services and whose needs lie more in the custodial and supportive realms describes:

assisted-living facilities.

Beginning in the 1980s, a significant advance in the provision of hospital emergency department services occurred with the introduction of

board-certified emergency medicine physicians.

The predominant services of local public health departments today are

child and adult immunizations

Ambulatory care capacity has undergone exponential increases in all of the following settings, except:

community centers

In colonial America, mental health treatment consisted of

confinement in homes, jails, or almshouses where patients suffered severely

National awareness of the needs of the mentally ill rose sharply in the aftermath of WWI because

thousands of soldiers returned from the war suffering from "war neurosis" or "shell shock."

Hospital acquisitions of physician practices accelerated rapidly as hospitals prepared for health reform in the past decade. Creating physician networks allowed hospitals to be well-positioned to:

All of these are correct.

Which of the following accurately describes Interprofessional Collaborative Practice?

An understanding and appreciation for the roles and contributions of each discipline in the care of the patient and the unique community and population a patient belongs

In its landmark report on hospital errors, "To Err is Human," the Institute of Medicine emphasized that errors in care most typically originate from which one of the following sources?

Deficiencies in the systems of care

Continuing care retirement communities (CCRCs) are available for those Americans who wish to stay in their own homes as they get older.

FALSE

Cultural issues have proven to be unimportant in mentally ill persons' access to mental health services

FALSE

The ACA included many provisions to support primary care and development of the

Patient-Centered Medical Home (PCMH) model.

Who owns the largest percent of urgent care centers in the United States?

Physicians

Which of the following work under the supervision of a physician who specializes in the use and interpretation of radiographs and other medical imaging technologies?

Radiologic technologists

Which of the following describes ambulatory surgery?

Surgical and nonsurgical procedures performed on an outpatient basis

A fully vertically integrated system in its ideal form includes all facilities, personnel, and technological resources to render the complete continuum of care.

TRUE

A significant result of developments in ambulatory care delivery for hospital-operated and independent organizations has been physicians' entry into the business of outpatient diagnostic, treatment, and surgical services previously available to their practices in only the hospital setting.

TRUE

Which of the following is required to be employed as a clinical social worker?

A master's degree plus two years of supervised experience in a clinical setting

By 1817, a philosophical change occurred in Philadelphia when the Quakers established the first freestanding "asylum." Which of the following best describes a freestanding asylum?

A place where people with mental illness could receive kind, but firm, treatment while engaged in work, education, and recreation

A group of providers and suppliers involved in patient care that work together to coordinate care for the patients they serve under the traditional Medicare fee-for-service program is referred to as a(n)

Accountable Care Organization (ACO)

Which of the following organizations is responsible for approving the content of post-medical school residency training?

Accreditation Council for Graduate Medical Education

Which of the following best describes the Recovery Movement

Advocates for holistic care within the obvious context that a psychiatric illness or behavioral health issue is one aspect of a person's life

Disability-adjusted life years are calculated by finding the number of years of life lost to natural causes and adding the number of years lived with disability

FALSE

Evidence-based practice integrates the scientific knowledge with clinical skills and experience without always considering the unique needs of each patient.

FALSE

Hospitals are not required to make information on the Rights and Responsibilities of Hospitalized Patients known to every patient.

FALSE

Substance abuse and addiction are caused by a lack of will or moral failure

FALSE

Which of the following correctly describes the ACA system reforms' primary focus?

Healthcare delivery and reimbursement principles that make patient health outcomes most important, rather than delivery of discrete services.

Which of the following agencies develops and administers the licensing examinations that administrators take to get licensed by their respective states?

National Association of Boards of Examiners of Long-Term Care Administrators

Which act established federal, state, and county public funds to be allocated for mental health training, research, and service?

National Mental Health Act of 1946

Technological and clinical advances that allow many surgical procedures to be safely performed on an ambulatory basis had what corollary effect on hospitals?

Physicians became competitors with hospitals for the same lines of business.

Federal support of hospital construction was critically important to the location of hospitals in underserved rural areas in the mid-twentieth century

TRUE

Healthcare occupations are regulated, and how regulations are carried out varies from state to state.

TRUE

Patients in hospitals have individual rights, many of which are protected by state statutes and regulations.

TRUE

In 2003, the AHA replaced the Patient's Bill of Rights with a brochure titled:

The Patient Care Partnership.

Until the mid-1980s, hospitals were reimbursed for whatever they charged on a "retrospective" basis. Now they are paid a certain amount for each patient's care on a predetermined "prospective" basis. The amount they are paid is based on

diagnosis related groups (DRGs).

The healthcare workforce is rapidly evolving and responding to the complex needs of a diverse range of patients and populations. A high-performing and responsive health system that reflects its population should prioritize:

diversity, equity, and inclusion.

Many factors are associated with barriers to access for mental health care. One reason why fewer than 50% of Americans in need of mental health services actually receive them is

fear of family and social stigmatization.

Coordinated and comprehensive care and reductions in health disparities for low-income individuals, racial and ethnic minorities, rural communities, and other underserved populations best describes:

federally qualified health centers.

In the late 1980s, prospective hospital reimbursement replaced retrospective payment nationally through Medicare's initiation of the diagnosis-related group payment system. The new payment system provided:

financial incentives to decrease the duration of inpatient stays and to increase service delivery efficiency.

All of the following describe the Institute for Healthcare Improvement's Triple Aim, except:

improved prevention and wellness.

The Child Health Insurance Program was financed jointly by federal and state governments and:

increased the number of insured children in low-income families.

A cornerstone of the personal rights of hospitalized patients is the right to know and is referred to as:

informed consent

Which of the following accurately describes factors that influence the demand for healthcare professionals?

-Changing nature of the disease, disability, and treatment -Physician supply, technology -Expansion of ambulatory and home-based care All of these are correct.

Which of the following correctly describes certification?

-It is usually not state-based, and it is a much less restrictive regulation than licensing. -This means that the individual has obtained advanced or specialized training in a particular area of practice consistent with an established body of metrics. -Allows the public, employers, and third-party payers to determine which practitioners are appropriately qualified in their specialty or occupation All of these are correct.

Which of the following was a negative effect of changes in reimbursement mechanisms to a prospective payment system based on diagnosis-related groups?

-More rapid discharge of all patients from hospitals after episodes of hospitalization for acute illness -Patients frequently are discharged to their homes while still requiring advanced intensive therapeutic treatments. -More rapid discharge of all patients from hospitals after episodes of exacerbation of the chronic disease, progression of disability, or surgery -All of these are correct.

In today's healthcare system, a patient stays in the hospital until the physician decides that he or she is well enough for discharge, and each hospital monitors its own situation through review committees.

FALSE

In today's hospitals, the Emergency Department is a place of indenture for medical students or medical residents who are required to provide coverage as a component of their training or who are "moonlighting" for extra money.

FALSE

The focus of the healthcare delivery system in the United States has shifted from expanded use of ambulatory care services to hospital based inpatient care.

False

The World Health Organization ranking of the leading causes of disability in the U.S. in terms of the total number of years lost to illness, disability, or premature death places neuropsychiatric disorders at what level?

First

Which of the following are responsible for the activities of the medical records departments of hospitals, skilled nursing facilities, managed care organizations, rehabilitation centers, ambulatory care facilities, and several other healthcare operations?

Health information administrators

Healthcare system changes, including advancing technology, will likely result in new, more highly specialized health occupations. Which of the following is not one of the expected effects of this development?

Hospitals' resistance to employing multi-skilled personnel

All of the following are causes underlying the intensifying need for diverse long-term care service options EXCEPT

Improvements and innovations in home care

Which of the following best describes horizontal integration?

Large groups of hospitals merged into one organization can purchase supplies and services at a volume discount, hire specialized staff at the corporate level to increase expertise, raise capital less expensively, and market hospital services under a single brand name in several communities.

Which of the following is a responsibility of a discharge planner?

Making necessary, specific arrangements for follow-up services

Which of the following describes the similarities between a Doctor of Medicine and a Doctor of Osteopathic Medicine?

May use all accepted methods of treatment, including pharmaceutical drugs and surgery -All states require physicians to hold a license to practice medicine. -Physicians must attend an accredited school that awards a Doctor of Medicine or a Doctor of Osteopathic Medicine degree. -All of these are correct.

Which of the following describes an attending physician?

Medical staff who have completed their training and are in practice

Although EDs are designed to care for life-threatening illness or injury, EDs also deliver routine medical care

TRUE

Many insurers now require a confirming second opinion before agreeing to pay for certain surgical or other procedures. Medicare and many private health plans cover most of the costs of second opinions.

TRUE

Organizations increasingly recognize that employee wellness is tied to organizational performance and wellness.

TRUE

Successfully completing a residency makes a physician "board eligible," in other words, eligible to sit for one of the 24 medical specialty boards.

TRUE

The Social Security Act provided financial assistance for particular categories of older Americans and people with disabilities.

TRUE

The primary healthcare delivery sector is often the initial point of contact and may be the only source of contact for a large proportion of people with psychiatric or behavioral health disorders.

TRUE

Through insurance coverage for people previously uninsured for financial reasons, or barriers due to pre-existing conditions, the Affordable Care Act improves access to behavioral health services.

TRUE

Which of the following distinguishes acute care hospitals from long-term care facilities such as nursing homes, rehabilitation centers, and psychiatric hospitals?

The average length of stay for patients is less than 30 days.

Using a team-based approach to deliver patient care that promotes the health, safety, and outcomes of patients, clients, families, caregivers, and communities best describes:

interprofessional practice

Following the Congressional hearings and simultaneous public outcry, Medicare and Medicaid guidelines and the credentialing and increased establishment and enforcement of nursing home and home care licensure were initiated. All of the following describe the actions put into place, except:

legislation to prevent false insurance claims.

To provide direct patient care, physicians are required to do all of the following except

participate in approved collaborative training programs with allied health professionals.

The primary organizational mode of medical care in the United States, in terms of volume of services delivered, is

physicians' offices.

"Urgent Care" is best described as care

provided on a walk-in, extended-hour basis for acute illness and injury that is either beyond the scope of or availability of a primary care practice or retail clinic.

A Patient-Centered Medical Home (PCMH) is best described as a:

team-based model of care led by a personal physician who provides continuous and coordinated care throughout a patient's lifetime to maximize health outcomes.

All of the following describe clinical practice guidelines, except:

they are issued by third-party organizations, whose guidelines define the role of specific diagnostic and treatment modalities in diagnosing and managing patients.

Long-term care requires a seamless continuum of care. Seamless continuum of care refers to:

uninterrupted care that adjusts depending on a patient's changing needs

Clinical observation units (COUs) may be best described as hospital units associated with emergency departments which

use a period of 6-24 hours to triage, diagnose, treat, and monitor patients with common complaints.