PH 129 Exam 1 (chapter 7)

Hospice

A cluster of special services for the dying, which blends medical, spiritual, legal, financial, and family-support services. The venue can vary from a specialized facility to a nursing home to the patient's own home.

Walk-in clinic

A freestanding, ambulatory clinic in which patients are seen without appointments on a first come, first served basis.

Surgi-center

A freestanding, ambulatory surgery center that performs various types of surgical procedures on an outpatient basis.

Explain the concept of hospice care and describe the types of services provided by hospices.

Hospice care is services provided to ill patients and their family with a life expectancy of 6 month or less. Hospice care is a method of care, not a location. Provide: medical, psychological, and social services. 2 primary: (1) pain and symptom management (2) psychosocial and spiritual support.

Community-oriented primary care

Incorporates the elements of good primary care delivery and adds a population-based approach to identifying and addressing community health problems.

Describe the scope of public health ambulatory services in the U.S..

Literature shows that lower rates of hospitalization for ambulatory care-sensitive conditions are associated with receiving primary care Two types of LTC ambulatory services: 1. case management - provides coordination and referral among a variety of health care services. 2. Adult day care - compliments the informal services a family member could have been providing during the day.

Complementary and alternative medicine

Refers to the broad domain of all health care resources, other than those intrinsic to biomedicine.

Describe how some of the changes in the health services delivery system have led to a decline in hospital inpatient days and a growth in ambulatory services.

Reimbursement for outpatient care increased technological factors: less invasive surgeries physician practice factors: starting own specialty ambulatory care centers social factor: patients want to stay at home and have independence

Secondary care

Routine hospitalization, routine surgery, and specialized outpatient care, such as consultation with specialists and rehabilitation. Compared to primary care, these services are usually brief and more complex, involving advanced diagnostic and therapeutic procedures.

Gatekeeping

The use of primary care physicians to coordinate health care services needed by an enrollee in a managed care plan.

Briefly explain how a telephone triage system functions.

When physician's offices are closed and a patient requires expert opinion and advice on health, they have the trained nurses who have access to patient medical records and provide guidance with the use of standardized protocols. They can consult with primary care physicians when necessary or refer patients to urgent care or ED.

Why is it important for hospital administrators to regard outpatient care as a key component of their overall business strategy?

a. Growth in outpatient settings i. Changes in reimbursement ii. Development of technology iii. Utilization controls iv. Social factors b. Advantages of hospital outpatient departments i. Significant contribution to profits, continuum of services, cross-referrals within a hospital's own network c. Advantages to physicians (outpatient) i. Lower operating costs, greater opportunities to contract with managed care ii. Advantages to patients (outpatient) 1. Most routine services available at one place, cross-referrals, hospital-based

Discuss the two main factors that determine what should be an adequate mix between generalists and specialists.

a. The first factor is how rigidly a health delivery system employs the concept of gate keeping. The British National Health Service, for instance employs this concept more rigidly than the Canadian health system. Consequently, the proportion of primary care physicians is 50% in Canada, compared to 70% in Britain. In the United States, gate keeping is gaining prominence in the managed care system. Consequently, the proliferation of healthcare delivery through managed care is creating a greater demand for primary care physicians. The second factor driving the need for primary care providers is the propensity of people in a given population to utilize primary care services. Greater utilization suggests more professionals are needed to adequately serve a population. It is estimated that about 75%-85% of people in a general population require only primary care services in a given year. However, these proportions will vary in populations with special healthcare needs.

What are 5 main hospital-based outpatient services?

-Clinical (typically for the uninsured or those in research studies) -Surgical (patients are discharged on the day of surgery) -Home health care (postacute care and rehabilitation) -Women's health -Traditional emergency care

Define outpatient care. What are several key changes that have been instrumental in shifting the balance between inpatient and outpatient services?

1. Definition: refers to any health care services that do not require an overnight stay in an institution of health care delivery, such as a hospital or long-term care facility 2. Outpatient care includes much more than primary care services In recent years, the process of health care delivery has increasingly shifted away from expensive stays in acute care hospitals, and many intensive procedures are increasingly performed on an outpatient basis

Urgent care center

A walk-in clinic that is generally open to see patients after normal business hours in the evenings and weekends without having to make an appointment.

Ambulatory care

Also referred to as outpatient services. Ambulatory care includes (1) care rendered to patients who come to physicians' offices, outpatient departments of hospitals, and health centers to receive care; (2) outpatient services intended to serve the surrounding community (community medicine); and (3) certain services that are transported to the patient.

What is alternative medicine? What role does it play in the delivery of health care?

Alternative medicine refers to broad domain of all health resources, other than those to biomedicine (traditional medicine). Some treatments include, homeopathy, herbal remedies, natural products, etc. No single health care delivery setting is involved in alternative medicine or treatments. However, many are interested un the growing medical establishment.

The term "ambulatory care" is used interchangeably with "outpatient services." Explain the difference.

Ambulatory care consists of diagnostic and therapeutic services and treatments provided to the "walking" (ambulatory) patients. Patent's who came to physician's offices, outpatient departments to receive care. Some outpatients services maybe offered by hospital or long term care facility.

Outpatient services

As opposed to inpatient services, outpatient services include any health care services that are not provided based on an overnight stay in which room and board costs are incurred. See ambulatory care.

Describe the main public and voluntary outpatient clinics, and the main problems they face.

Community health centers are supported by grant funding administered. These centers are required by law to help anyone seeking help even if they are uninsured and cannot afford to pay.

Discuss the gatekeeping role of primary care.

Gatekeeping implies that patients do not visit specialists and are not admitted to a hospital without being referred for such care by their primary care physicians.

What implications has the decline in hospital occupancy rates had for hospital management?

Hospital occupancy rates have declined for more than 2 decades, and hospital executives have increasingly viewed an outpatient care as an essential portion of their health care business. Establishing a firm position in the outpatient care market has become critical to continue hospital survival, as has expanding into services not previously considered part of these organizations' core business.

Why is the hospital emergency department sometimes used for nonurgent conditions? What are the consequences?

Hospitalizations for ambulatory care-sensitive conditions are less frequent when primary care is strong. It costs more in the long run for the hospitalization, etc costs.

What are mobile health care services? Name the three mobile facilities for medical, diagnostic, and screening services.

Medical health care services are transported to patients and constitute and efficient and convenient means by providing certain types of routine services. Such as mammography, and magnetic resonance imaging. Screening such as blood pressure and cholesterol are performed for anyone who walks in. Such mobile units take advanced diagnostic services to small towns and rural areas.

Medical home

Patient-centered care based on the principles of the chronic care model. Uses evidence-based guidelines; applies appropriate health information technology; and demonstrates the use of "best practices" to consistently and reliably meet the needs of patients while being accountable for the quality and value of care provided.

Palliative

Serving to relieve or alleviate, such as pharmacological pain management and nausea relief.

What are some of the reasons solo practitioners are joining group practices?

Solo practitioners have joined group practices, in which multiple providers consolidate their services under a single umbrella. Independent providers face capital constrains and competitive pressures in the health care market place.

What is community-oriented primary care? Explain.

The elements of good primary care delivery and adds a population based approach to identifying and addressing community health problems.

What are the main characteristics of primary care?

The main characteristics are it's duration, frequency, and level of intensity. Primary care provides services such as prevention, diagnostic and therapeutic services, health education and counseling and minor surgery. Primary care can be viewed as an approach to providing health care rather than as a set of specific services.

Tertiary Care

The most complex level of care. Typically, tertiary care is institution-based, highly specialized, and highly technological. Examples include burn treatment, transplantation, and coronary artery bypass surgery.

What is the basic philosophy of home health care? Describe the services provided through home health care.

The philosophy of maintaining people in the least restrictive environment possible. Services include: nursing care, such as changing dressings, monitoring medications, and help with bathing. S-T rehab, such as physical therapy, occupational therapy, and speech therapy. Homemaker services, such as meal preparation, shopping, transportation, and specific household chores. Medical supplies and equipment such as hospital beds, oxygen tanks, walkers and wheelchairs.

What is the main objective of this chapter?

To describe the important roles outpatient services and primary care play in today's health care delivery