보드바이탈
기밀유지
) Only the first name should be used. 환자부를때
Meaningful Use. 인가받은 프로그램 쓰게
-program instituted by Medicare and Medicaid - to improve quality, safety, and efficiency in healthcare through use of certified electronic health record technology -The Medicare and Medicaid EHR Incentive Programs provide financial incentives for the "meaningful use" of certified EHR technology -this program includes incentives for participation, demonstrated by meeting certain requirements over three stages
level of 리서치
2. Systematic reviews and meta-analyses of RCTs 4. RCTs 6. Cohort studies 3. Case-control studies 1. Cross-sectional surveys 5. Case reports
IP
D) The primary responsibility for developing core competencies is with health professions schools.
In addition to implementing the Electronic Health Record, Title XII of the American Recovery and Investment Act of 2009, known as the HITECH Act, contains provisions to promote the use of health information technology to improve healthcare quality, safety, and efficiency. Which term is significant with regards to this policy? Correct answer: (B) Meaningful use.
HITECH Act as -e-prescribing -engaging in health information -exchange submitting information regarding quality measures.
HMO stands for
Health maintenance organization, which is a type of insurance plan.
Advisory Council on Nursing Education and Practice and the Council on Graduate Medical Education
Improve interdisciplinary efforts between nurses and physicians to improve client safety and reduce errors
ACA
Medicare was to reimburse a 10% bonus for services through January 1, 2016, for NPs practicing in professional shortage areas.
Omnibus Budget Reconciliation Act (OBRA)
OBRA establishes guidelines for nursing facilities, such as long term care.
Americans with Disabilities Act (ADA)
The ADA provides physically and mentally disabled patients access to employment and the community.
Medicare
The NP must meet educational and licensure requirements for nurse practitioners and must bill using a National Provider Identification number (NPI number).
HITECH Health Information Technology for Economic and Clinical Health Act. 전자시스템 쓰기 장려?
This act was enacted under the American Recovery and Reinvestment Act of 2009 to promote and expand the adoption of health information technology.
certification
Whether she has achieved recognition of certain advanced skills and knowledge.
CPOE Computerized physician/provider order entry (CPOE)
a clinical software application that automates medications and treatment ordering.
A nurse practitioner is studying a new program that has been implemented in her organization to increase the percentage of patients with chronic stable coronary artery disease who have been prescribed lipid-lowering agents. What type of quality measure does this describe? Correct answer: (C) Process. Explanation: Clinical quality measures used to assess the performance of individual clinicians, clinical delivery teams, delivery organizations, or health insurance plans in the provision of care to their patients or enrollees include process measurements, which generally consist of a measure of patients eligible for a particular service in the denominator and the number of patients who do or do not receive the service in the numerator. Process measures are supported by evidence that the clinical process has led to improved outcomes.
(A) Access measures refer to the measure of attainment of timely and appropriate health care by patients or enrollees of a healthcare organization or clinician. (B) Use of service measures can assess provision of service to patients or enrollees through encounters, tests, or interventions that are not supported by evidence for appropriateness of the service for the specified individuals. (D) Population outcomes are measures of the health of a population as a result of a public health intervention.
Which of the following styles of conflict management by a nurse practitioner is a win-lose situation that results in meeting the NP's goals? Correct answer: (D) Competition. Explanation: Competition is characterized by pursuing one's own goals at the expense of another. It is a win-lose situation, but may work to resolve conflict when a rapid or unpopular decision must be made.
(A) Accommodation results in meeting the goals of the other party, and is described as a lose-win situation. (B) Avoidance, the technique most overused by nurses to resolve conflict, results in failure to address the conflict and creates a lose-lose situation. (C) Compromise can be effective when two parties of equal power need to arrive at a rapid solution. It is described as a lose-lose situation, as neither party prevails.
nurse practitioner is researching the percentage of patients in a health plan with an inpatient admission during the prior twelve months. What type of quality measure best describes her research? Correct answer: (B) Use of service. Explanation: Use of service refers to the provision of a service to, on behalf of, or by a group of persons identified by enrollment in a health plan or through use of clinical services. These measures can assess encounters, tests, or interventions that are not supported by evidence for appropriateness of the service for the specified individuals.
(A) Management quality measures refer to measures that assess administrative activities that are important to health care but not part of a direct interaction between individual patients and health care professionals. (C) Efficiency measures are measures of the relationship between a specific level of quality of health care service and the resources used to provide that care, typically the cost of care. (D) Patient experience refers to a measure characterized by a patient or enrollee's report of observations and participation in health care, or any assessment of the resulting change in their health.
Assessment of a public health program to reduce smoking in a Midwestern state is performed by asking smokers if they have seen or heard public service announcements promoting the statewide tobacco-cessation program. Which type of quality measure does this represent? Correct answer: (B) Population experience. Explanation: A population experience measure is a report by the members of a population about their observation of or participation in a public health program. These measures are supported by evidence that an association exists between the measure and population values and preferences or another population health domain.
(A) Population access measures describe access to the timely and appropriate receipt of a public health intervention. (C) Population use of services measures are considered "related population health measures" that assess non-quality aspects of public health programs or population-level health characteristics, which may not be directly attributable to the care delivery system. The use of services measures refers to the provision of services to, on behalf of, or in use by a population. An example would be a measure of the percentage of assisted-living facility beds that are occupied in a county. (D) Population health knowledge assesses awareness and understanding of health-related information, including prevention strategies, risk factors, and treatment recommendations.
호스피스 6달
(A) The physician must certify that the patient has a life expectancy of less than 6 months. (B) In order for a patient to be admitted to hospice care, a physician must write an order. Currently, Medicare does not allow NPs to refer patients to hospice. (C) In some states NPs are allowed to sign the death certificate, this varies state to state.
(A) Grandfathering refers to a statutory process that includes previously licensed persons without any further revisions or additions to nurse practice acts.
(B) Mandatory revocation refers to a function of the State Board of Nursing with respect to licensure.
The correct format for the null hypothesis is
, "There is no significant difference between the two group
PDSA (Plan-Do-Study-Act). PDSA stands for the "Plan-Do-Study-Act" cycle, which is a scientific model -for improvement that has been implemented by the Institute for Healthcare Improvement -to accelerate the process of bringing quality care to patients and facilitate change.
- used by the (Institute for Healthcare Improvement) to direct quality improvement programs and to facilitate change
<the legislative process> During the legislative process, if a bill is passed on the floor with amendments, what occurs next? Correct answer: (C) The bill is returned to the original house.
-begins when a bill is introduced. - then assigned to a committee, (which provides education for the committee members and public about the bill.) - after committee hearings and passes - the bill is sent to the floor -, it is sent to the other chamber. -If a bill is passed with amendments in the second chamber of the Congress, (위 세문장은 같은곳) -the bill is returned to the original legislative house for approval, (after which the bill is sent to the president-->마지막단계 if the original house concurs with the amendments.) ->become law _______ (A) If a bill is passed on the floor with amendments by one house of Congress, it is returned to the original house for approval. If the original chamber concurs, the bill will then go to the president for signature or veto. (B) A bill that has been passed on the floor of one house of Congress with amendments will go to the original house for approval of the amended bill. (D) The original house that introduced the bill must concur with the amended bill before it is sent to the president, who must sign the bill before it becomes law. The president can also veto(거부) a bill.
부모동의필요없는
-std치료 -임신 케어 -피임 but but permanent surgical contraception is an exception to this. Contraceptives, abortion, drug and alcohol counseling, and prenatal care are among those exceptions. diagnosis and treatment of venereal or sexually transmitted diseases, diagnosis or treatment of reportable, infectious, contagious, or communicable diseases; and HIV/AIDs testing and treatment. Other services for which a minor may give consent in one or more of the states in the US include contraceptive services, abortion, emergency care, prenatal care, collection of medical evidence, treatment for sexual assault, mental health services, and counseling or treatment for drug or alcohol use or abuse.
two general categories of legislation
<Appropriations bills> originate in the House of Representatives (하원) provide (spending authority) for a single fiscal year, from the first of October through September 30. General appropriations bills provide (budgeting authority) for most federal agencies *Supplemental appropriations -provide additional funding for projects as needed through the current fiscal year. *Continuing appropriations -extend appropriations from one fiscal year to the next. <Authorization bills> -establish laws or programs and although they recommend dollar amounts in some cases, they do not allocate the funds or guarantee funding for a program. -Authorization bills establish laws or programs and they may contain recommended dollar amounts, which must be funded by appropriations bills.
Inductive. reasoning developing generalizations from specific observations.
A nurse practitioner notices that a child with a mother who smokes appears to have frequent upper respiratory infections. She then assumes all children who have mothers who smoke will develop frequent upper respiratory infections. What type of reasoning is she using?
Name the federal law allowing parents to provide insurance coverage for their children on a family policy until age 26:
Affordable Care Act. Explanation: The affordable Care act also prevents insurance companies from limiting or denying coverage due to preexisting medical conditions.
pay
An established patient agrees to pay the Nurse Practitioner directly for providing a specific service, which is a: Correct answer: (A) Fee for service system. Explanation: Fee for service reimbursement occurs when the patient pays the nurse directly for specific services provided. (B) Third party reimbursement includes private insurance and is the most common type of reimbursement. (C) The NP signs a contract and agrees to provide health care for a certain population, such as the homeless. ( Contracted service system) (D) Second party reimbursement occurs when a legal guardian/guarantor makes a direct payment for services.
You are compiling monthly statistics for your practice, and one of the elements of your analysis is the cultural background of your clients. What level of data is "cultural background"?
Correct answer: (A) Nominal level data. Explanation: The variable of "cultural background" is categorical data or nominal data
researcher is studying the death rates in two countries. Which of the following should she use to compare them?
Correct answer: (A) Standardized mortality rate. Explanation: Death rates are computed based upon the specific group studied. The standardized mortality rate is an adjusted rate that accounts for variables like age that may influence the mortality of a population.
HMO
Correct answer: (A) The patient can see any specialist within the HMO but must first see a PCP enrolled in the HMO network. Explanation: Patients in a health maintenance organization are assigned to a primary care provider who acts as a gatekeeper. The participating healthcare provider is paid a set amount each month per patient. The check comes from the HMO. It is the same, regardless of services provided. If the patient sees a specialist or consultant, the PCP must approve the referral. Patients are limited to specialists and consultants within the HMO network. Physicians who are out of network or not referred by the PCP may not be covered or may be subject to lower reimbursement. In an HMO, patients typically pay a set co-pay at each visit, in addition to the monthly fee paid on the patient's behalf by the HMO.
Which of the following acts allowed direct reimbursement to nurse practitioners by Medicare?
Correct answer: (B) Balanced Budget Act of 1997. Explanation: The Balanced Budget Act of 1997 was signed into law by President Bill Clinton and allowed direct reimbursement of nurse practitioners by Medicare.
Which of the following refers to the process of making the link between theory and practice by consciously thinking through an experience to develop a greater understanding?
Correct answer: (B) Reflective practice. Explanation: Reflective practice is the process of thinking through an experience to develop a greater understanding of the link between theory and practice by consideration of the process of thinking, including preconceptions, beliefs, and evidence underlying the thought process
Which of the following is the most widely used tool for assessing the healthcare safety culture within an organization?
Correct answer: (C) Culture of Patient Safety Assessment developed by AHRQ. AHRQ (Agency for Healthcare Research and Quality.)
Which of the following laws requires most hospitals to provide an examination and necessary stabilization treatment without consideration of insurance coverage or ability to pay?
Correct answer: (C) EMTALA. Explanation: The federal Emergency Medical Treatment and Labor Act, EMTALA, is also known as the Patient Anti-Dumping Law and requires most hospitals to provide an examination and needed stabilizing treatment, without consideration of insurance coverage or ability to pay, when a patient presents to an emergency room for attention to an emergency medical condition.
In order to obtain reimbursement from Medicare, the NP must learn how to use the:
Correct answer: (C) Healthcare Common Procedure Coding System (HCPCS). Explanation: CMS uses the HCPCS to determine reimbursement to providers which includes the CPT codes, but also includes other codes for services not covered by CPT codes.
When considering implementation of, or reporting on, quality improvement measures, which of the following should be kept in mind?
Correct answer: (D) The numerator in an item-by-item measurement of a quality improvement measure is the number of patients for whom the item was performed. Explanation: Quality improvement measures can either be reported as an item-by-item measurement or as an all-or-none measurement. The item-by-item measurement measures performance of each item in a quality measure. The numerator분자 is the number of people for whom the item was performed and the denominator 분모 is the total number of people eligible to receive the care. (A) The all-or-none measure is the most sensitive scale for assessment of improvement. (B) All-or-none measurement is the most sensitive scale for assessment of quality improvement performance. (C) Four of the measures for pneumonia performance set by JCAHO are *discrete* variables, including oxygenation assessment, pneumococcal vaccination, blood cultures, smoking-cessation counseling, and mean time of antibiotic initiation.
Emergency Medical Treatment and Active Labor Act (EMTALA)
EMTALA is designed to prevent patient "dumping" from emergency departments, premature discharge for economic reasons.
nurse practitioner would like to begin practice near a community of seniors. Which of the following is true concerning nurse practitioner reimbursement by Medicare? Correct answer: (B) Nurse practitioners can be reimbursed directly by Medicare Part B.
Explanation: Medicare's coverage of nurse practitioner services was broadened by the Balanced Budget Act of 1997. Nurse practitioners (NPs) can be reimbursed directly by Medicare Part B, Medicaid, Tricare, and some health insurance plans. Medicare will reimburse nurse practitioners at 85% of the usual and customary fee paid to a physician. The NP should file charges under his or her name and provider number for reimbursement. Previously, Medicare only directly paid NPs who practiced in certain rural/designated areas in the United States.
Which of the following are true of standards of practice for nurse practitioners, including psychiatric nurse practitioners? (Select all that apply) Correct answer: (B) (D)
Explanation: Standards of practice in nursing refer to authoritative statements of the duties that all nurses are expected to perform competently, regardless of role, specialty, or patient population. Among the standards of psychiatric mental health nursing standards is development of expected outcomes of treatment, as measurable goals and to provide direction for continuity of care. Coordination of care delivery is another standard of care for advance practice psychiatric mental health nurse practitioners. (A) *Quality standards of care are determined by governmental agencies, professional societies, and licensing boards. They may be general in scope or specific.* (C) Time estimates for attainment of expected outcomes in psychiatric care are a standard of care for psychiatric mental health registered nurse practitioners.
) Sunset legislation. 날짜지나면 자동 기각
Explanation: Sunset legislation is sometimes included in a Nurse Practice Act and specifies that the act must be reviewed by a specific date or be automatically rescinded. This provision is included to ensure nursing legislation is current
A hospital is preparing their staff for a scheduled inspection as part of its accreditation process. Which of the following is an independent accrediting body for hospitals? Correct answer: (C) TJC.
Explanation: The Joint Commission (TJC) is an independent, non-governmental body responsible for accrediting hospitals and ensuring they meet quality, safety and industry standards
A nurse practitioner is ordering new prescription pads. Which one of the following must be printed on the pad? Correct answer: (A) Names of all clinics where the NP practices if the practice has several clinics.
Explanation: The NP's prescription pad should contain the NP's name, designation, and license number. The name of the clinic, address, and phone number should be printed on the pad. If the practice has several clinics, the other clinics where the NP practices should be listed on the pad. Some states do require the name of the physician(s) on the collaboration agreement to be printed as well.
When considering an evidence-based practice, which of the following are available resources that synthesize currently available research information? (Select all that apply) Correct answer: (B) (C) Cochrane Review and Clinical Practice Guideline.
Explanation: When investigating current evidence, use of available resources that synthesize current research can help to limit the time needed to collect evidence. Some resources that are available to synthesize this information include -the Cochrane Library, -Clinical Practice Guidelines, -the Cumulative Index to Nursing and Allied Health -Literature (CINAHL) -PubMed. (A) The Journal of the American Medical Association publishes selected articles, limited in scope. (D) Medical and nursing texts often fail to include the latest research information, due to delays in publication
A new treatment is discovered for congestive heart failure that results in improved survival time but no cure. Which of the following will occur in a population when the treatment is widely used? Correct answer: (C) The prevalence will increase.
Explanation: With a treatment that provides an extended survival time, the prevalence of a disease will increase in a population if the incidence of the disease remains the same. There is no reason to conclude the incidence of congestive failure will change in the population. The same number of people will develop congestive heart failure each year, but those with the disease will live longer. With long-term chronic illnesses, the prevalence will be greater than the incidence and with short-term illnesses like flu, the incidence may be higher than the prevalence.
A nurse practitioner notices several medication errors that she believes could be avoided with new procedures. Which of the following pathways should she take to improve patient care?
Health risk management. Explanation: Health risk management is an organization process for the systemic identification of risky practices to minimize adverse patient outcomes and corporate liability. Areas that are usually addressed by risk managers include medication errors, hospital-acquired infections, patient identification problems, and falls.
통계학
Inferential statistics are used for hypothesis testing. Descriptive statistics are used to describe the sample.
NP
Nurse practitioners are regulated by the Nurse Practice Act of the state where he or she plans to practice. The legal right to practice is derived from state law, which contains regulations that mandate educational requirements, responsibilities, and scope of practice for nurse practitioners (and other nurses in the state). NP practice is not regulated by the federal government, the Department of Health and Human Services, or the American Medical Association. Enforcement of each state's Nurse Practice Act is the responsibility of the state board of nursing, a formal governmental agency with statutory authority to regulate nursing practice. The board of nursing in each state has legal authority to license, monitor, and discipline nurses. The board of nursing also has the authority to revoke a nurse's license, after formal hearing. (A) The first NPs were pediatric NPs who practiced in rural areas with a shortage of physicians. (B) Dr. Loretta Ford and Dr. Henry Silver developed the first Nurse Practitioner (NP) program at the University of Colorado in 1965.
The federal law that allows parents to provide insurance coverage for their child until age 26 is the: Correct answer: (B) Affordable Care Act (ACA). Explanation: ACA is the program that allows parents to provide insurance cover their children to the age of 26. (A) The OAA provides social services for Native Americans and older Americans. (C) COBRA enables Americans who change employment to continue health insurance coverage for a certain amount of time while they look for other employment. (D) The ADA protects disabled Americans from discrimination because of their disability.
Older Americans Act (OAA) B. Affordable Care Act (ACA) C. Consolidated Omnibus Reconciliation Act (COBRA) D. Americans with Disabilities Act (ADA)
Identify the law that provides improved access to transportation for older and Native Americans: Older Americans Act (OAA)
Older Americans Act (OAA). Explanation: Older Americans Act (OAA) provides improved access to services for older and Native Americans, including community services.
High Reliability Organizations.
Organizations with a culture of safety, that foster a learning environment and evidence-based care, promote positive working environments for nurses, and are committed to improvements in safety and quality care are considered to be high reliability organizations (HROs.) In their culture centered on safety and quality, there is direct involvement of top and middle leadership, and safety and quality efforts are aligned with the strategic plan. There is an established infrastructure for safety with active engagement of staff and continuous improvement.
The IOWA model of EBM was developed to describe knowledge transformation and to guide implementation of research into clinical practice.
Press-Ganey surveys are instruments used to determine patient satisfaction.
support system
Semiformal. Semiformal support systems provide physical and emotional assistance. They include organizations and agencies in the community that provide goods and services. Formal support is regulated by laws or statues. 1) Formal social support is provided by social workers, 2) financial support by Social Security, 3) medical support provided by Medicare. (C) (D) Informal support derives from the social network, includes family, and friends, but only those who actually provide assistance in some way.
A bonus formula specifies conditions under which an employer rewards an NP for superior performance.
Termination clauses often specify that the employer may end the agreement without cause with 30 days notice.
중요
The NP knows that his or her legal right to practice is derived from: Correct answer: (B) The Nurse Practice Act of the state where he or she practices. Explanation: The Nurse Practice Act of the state gives every nurse the legal right to practice nursing. (A) The laws of the state give the Board of Nursing the authority to enforce the Nurse Practice Act. (C) The federal Medicare laws provide funding for health care for older adults aged 65 years and older. (D) The Board of Nursing is the agency that is tasked with enforcing the Nurse Practice Act in the state.
A nurse practitioner is employed in a medical clinic and her employer requires that all patients who need home health services are referred to an agency in which he has a financial interest. The NP should be concerned about violation of which law? (C) Stark.
The Stark Law states that a physician cannot refer a patient covered by Medicare to a clinic or laboratory in which the physician or an immediate family member of the physician has a financial relationship.
Clinical decision support system (CDSS).
The applications contain a database of medical knowledge. An evidence based inference system provides patient specific advice. Interactive software applications that provide information to physicians or other healthcare providers to help with healthcare decisions
Which of the following is the lead principle for a new paradigm of mental health care in plans suggested by SAMHSA and the President's New Freedom Commission?
The lead principle of plans for transformation of mental health care in paradigms suggested by SAMHSA, NAMI, the IOM, and the President's New Freedom Commission is recovery, which emphasizes the reawakening of hope, engagement in life, and empowerment over illness.
NEAR MISS
The nurse determined that the wrong limb was marked for amputation and notified the surgical team. Surgery was performed on the correct extremity. This is an example of which of the following? Correct answer: (A) Near miss. Explanation: An error was discovered and changed prior to the procedure. The client was not harmed. (B) A sentinel event results in serious psychological or physical injury or death. (C) When a necessary procedure or intervention is not performed and injury or death occurs, it is called an error of omission. (D) A preventable adverse event is an injury that could have been avoided. It is due to a mistake or flaw in the healthcare system design.
Health maintenance organizations
are organizations that provide or arrange managed care for insurance or benefit plans, individuals, and other entities.
CLAIM BASE COVER
at the time the claim is filed in court
Case management 만성환자 코디네이션- 외래
coordination of outpatient management of patients with certain diagnoses, usually chronic diseases. It is often done by telephone by an experienced RN.
HIPAA Health Insurance Portability and Accountability Act,
enacted in 1996. This act ensures -equal access to certain health and human services and -protects the privacy and security of health information. -rights of the individual and family to continue insurance after a job loss or change, Explanation: HIPPA addresses the rights of the individual and family to continue insurance after a job loss or change, and to maintain the privacy of their health information. HIPAA is the acronym for the Health Insurance Portability and Accountability Act that was passed by Congress in 1996. HIPAA does the following: - Protects the transfer health information for continuity of care - Reduces health care fraud and abuse - Mandates industry-wide standards for health care information on electronic billing and other processes - Requires the protection and confidential handling of protected health information -Addresses the rights of the individual, as they relate to privacy of health information B. Requires national standards for electronic health records C. Regulates transfer of health information needed for continuity of care D. All the above
accredited health care organization
has been reviewed and has met predetermined standards set by an accrediting body, such as the Joint Commission.
Preferred provider organizations (PPOs)
managed care organizations composed of doctors, hospitals, and other healthcare providers who have agreed with a third party or insurance company to provide care at reduced rates to participants in the plan.
V-codes are 방문이유!
modifiers that indicate the reason for a visit, but cannot be used for procedures.
Reimbursement policies, scope of practice regulations, and licensure regulations for NPs are determined by individual state
not federal!
Risk management
organizational process within a health system that is designed to identify risky practices to minimize adverse outcomes and corporate liability.
Quality improvement programs
programs that are instituted in a system in response to identification of a problem. These programs are designed to improve quality of care, decrease complications, decrease hospitalizations, lower patient mortality, decrease system errors, and increase patient satisfaction.
The computerized notification system
provides alerts to abnormal lab results or imaging results.
CMS
refers to the Centers for Medicaid and Medicare Service.
What tool are they using to track their progress?
run chart
DRG Diagnosis Related Group,
which is a statistical system of classifying inpatient stay into groups for the purpose of payment. Correct answer: (B) DRG. Explanation: Diagnosis-related groups (DRGs) are groups related to a diagnosis with a fixed reimbursement amount. Adjustments are based upon the severity of the case, teaching costs, and area of service (rural/urban/regional). Hospitals receive a set dollar amount for each client based upon the DRG, regardless of the client's length of stay or use of services.
COBRA stands for <Consolidated Omnibus Budget Reconciliation Act,>
which provides for continuation of an employer's preexisting group health insurance for a fixed period for an individual who loses coverage.
고소
고소한사람: plaintiff 당한사람: defendant