Transcript Home Care
Chapter 2
The Health Care Delivery
System
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
Challenges to Health Care
Reducing health care costs while maintaining
high-quality care for patients
Improving access and coverage for more
people
Encouraging healthy behaviors
Earlier hospital discharges result in more
patients needing nursing homes or home
care.
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Emphasis on Population Wellness
Health Services
Pyramid
{Fig 2-1 here}
Managing health
instead of illness
Emphasis on
wellness
Injury prevention
programs
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National Priorities Partnership
National Priorities:
Patient and family engagement
Population health
Safety/eliminating errors as possible
Care coordination
Palliative care for advanced illnesses
Overuse/reducing waste
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Institute of Medicine (IOM)
Nurses need to be transformed by:
Practicing to the full extent of their education and
training
Achieving higher levels of education and training
through an improved education system that
provides seamless progression
Becoming full partners, with physicians and other
providers, in redesigning the health care system
Improving data collection and the information
infrastructure for effective workforce planning and
policy making
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Case Study
Amy Sue Reilly is a 15-year-old white female of Irish
descent. She is a freshman at a Catholic high school.
Although her parents are divorced, Amy Sue reports
that her family (she has two brothers and lives with
her mother) is very close, and that her parents work
together to meet all their children’s needs.
Amy Sue has had asthma since she was 5 years old.
She has been able to control her asthma by taking
oral medications and by using inhalers when needed.
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Health Care Regulation and
Competition
Regulatory and competitive approaches
Professional standards review organizations
(PSROs)
• Created to review the quality, quantity, and cost of
hospital care provided through Medicare and Medicaid
Utilization review committees (URs)
• Review admissions, diagnostic testing, and treatments
provided by physicians who cared for patients receiving
Medicare
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Health Care Regulation and
Competition (cont’d)
Prospective payment system (PPS)
Diagnosis-related groups (DRGs)
Capitation
Resource utilization groups (RUGs)
Profitability
Managed care
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Health Care Regulation and
Competition (cont’d)
Patient Protection and Affordable Care Act
Access to health care for all
Reducing costs
Improving quality
Provisions include
• Insurance industry reforms
• Increased funding for community health centers
• Increased primary care services
• Improved coverage for children
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Health Care Settings and Services
1. Preventive
2. Primary
3. Secondary
4. Tertiary
5. Restorative
6. Continuing
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Health Care Accreditation/
Certification
Reasons:
Accreditation earned by the entire
organization
To demonstrate quality and safety
To evaluate performance, identify problems, and
develop solutions
Specific programs or services within an
organization earn certifications.
The Joint Commission and others
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Preventive and Primary Health Care
Preventive Care
Primary care
Focuses on improved health outcomes for an entire
population
Requires collaboration among health professionals,
health care leaders, and community members
Health promotion lowers overall costs:
Reduces incidence of disease
Minimizes complications
Reduces the need for more expensive resources
Occurs in home, work, and community settings
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Secondary and Tertiary Care
Also called acute care
Focus: Diagnosis and treatment of disease
Disease management is the most common
and expensive service of the health care
delivery system.
20% require 80% of health care spending.
Fastest growing age group of uninsured?
Postponement of care by uninsured
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Secondary and Tertiary Care
(cont’d)
Settings
Hospitals
Rural
Hospitals
Intensive Care
Units
Psychiatric
Care
Resource efficiency, word redesign
Discharge planning—nurses’ role
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Restorative Care
Serves patients recovering from an acute or
chronic illness/disability
Helps individuals regain maximal function and
enhance quality of life
Promotes patient independence and self-care
abilities
Requires multidisciplinary approach
Settings:
Home Care
Rehabilitation
Extended Care
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Restorative Care: Home Care
Provision of medically related professional and
paraprofessional services and equipment to patients
and families in their homes for health maintenance,
education, illness prevention, diagnosis and
treatment of disease, palliation, and rehabilitation
Involves coordination of services
Focuses on patient and family independence
Usually reimbursed by government (such as
Medicare and Medicaid in the United States), private
insurance, and private pay sources
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Restorative Care: Rehabilitation
Focus: To restore patients to their fullest
physical, mental, social, vocational, and
economic potential
Includes physical, occupational, and speech
therapy, as well as social services
Occurs in many health care settings, both
inpatient and outpatient
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Restorative Care: Extended Care
Extended care facility
Provides intermediate medical, nursing, or
custodial care for patients recovering from acute
illness or disabilities
Skilled nursing facility (intermediate care)
Provides care for patients until they can return to
their community or residential care location
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Continuing Care
For people who are disabled, functionally
dependent, or suffering a terminal disease
Available within institutional settings or in the
home:
Nursing Centers or Facilities
Assisted Living
Respite Care
Adult Day Care Centers
Hospice
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Continuing Care: Nursing Centers or
Facilities
Provide 24-hour intermediate and custodial
care
Nursing, rehabilitation, diet, social, recreational,
and religious services
Residents of any age with chronic or debilitating
illness
Regulated by standards: Omnibus Budget
Reconciliation Act of 1987
Interdisciplinary functional assessment is the
focus of clinical practice: MDS, RAIs
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Continuing Care: Assisted Living
—Offers a long-term care
setting with a home
environment and greater
resident autonomy
—Provides services such
as laundry, assistance
with meals, personal care,
housekeeping, and 24hour oversight
—Allows residents to live
in their own units
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Respite Care
The service provides short-term relief or “time
off” for persons providing home care to an ill,
disabled, or frail older adult.
Settings include home, day care, or health
care institution with overnight care.
Trained volunteers allow family caregivers to
leave the home for errands or social time.
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Quick Quiz!
1. A patient who needs nursing and
rehabilitation following a stroke would most
benefit from receiving care at a
A. Primary care center.
B. Restorative care setting.
C. Assisted-living center.
D. Respite center.
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Adult Day Care Centers
Provide a variety of health and social services
to specific patient populations who live alone
or with family in the community
May be associated with a hospital or nursing
home or may operate independently
Offer services to patients such as daily
physical rehabilitation and counseling
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Hospice
Family-centered care that allows patients to
live and remain at home
Focuses on palliative (not curative) care:
comfort, independence, and dignity
Provides patient and family support during
terminal illness and time of death
Many hospice programs provide respite care,
which is important in maintaining the health of
the primary caregiver and family.
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Case Study (cont’d)
Recently, Amy Sue has had some difficulty
breathing, especially during gym class.
Corrine is a 45-year-old African American
nurse, who recently accepted a job as a
school nurse for the four Catholic schools in
the area. Three of the schools are grade
schools, and one is Amy Sue’s high school.
Before she took this job, Corrine worked at a
pediatrician’s office.
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Issues in Health Care Delivery
Nursing shortage
Competency
Evidence-based practice
Quality and safety in health care/ Patientcentered care
Health care organizations are being
evaluated on the basis of outcomes such as
prevention of complications, patients’
functional outcomes, and patient satisfaction.
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Issues in Health Care Delivery
(cont’d)
Magnet Recognition Program
Nursing-sensitive outcomes
Nursing informatics and technological
advancements
Globalization of health care
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Case Study (cont’d)
Amy Sue’s difficulty managing her
asthma is significant for Corrine
because Corrine’s oldest daughter
has asthma.
In addition, because of her job in
the pediatrician’s office, Corrine
has had experience with caring for
children with asthma and with
helping patients access the health
care delivery system.
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Quick Quiz!
2. Technological advances in health care
A. Make the nurse’s job easier.
B. Depersonalize bedside patient care.
C. Threaten the integrity of the health care
industry.
D. Do not replace sound personal judgment.
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The Future of Health Care
Change opens up opportunities for
improvement.
Health care delivery systems need to address
the needs of the uninsured and the
underserved.
Health care organizations are striving to
become better prepared to deal with these
and other challenges in health care.
The solutions necessary to improve the
quality of health care depend largely on the
active participation of nurses.
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