Chapter 2

Question 1

Acute care

Answer 1

tertiary care; more costly

Question 2

Adult day care centers

Answer 2

provide a variety of health and social services to specific patient populations who live alone or with family in the community.

Question 3

Assisted living

Answer 3

offers an attractive long-term care setting with an environment more like home and greater resident autonomy

Question 4

Capitation

Answer 4

the providers receive a fixed amount per patient or enrollee of a health care plan; aims to build a payment plan for select diagnoses or surgical procedures that consists of the best standards of care at the lowest cost.

Question 5

Diagnosis-related groups (DRGs)

Answer 5

Each group has a fixed reimbursement amount with adjustments based on case severity, rural/urban/regional costs, and teaching costs. Hospitals receive a set dollar amount for each patient based on the assigned DRG, regardless of patient’s length of stay or use of services.

Question 6

Discharge planning

Answer 6

Begins the moment a patient is admitted to a health care facility. It is a centralized, coordinated, interdisciplinary process that ensures that the patient has a plan for continuing care after leaving a health care agency. Often requires referrals to various health care disciplines.

Question 7

Extended care facility

Answer 7

provides intermediate medical, nursing, or custodial care for patients recovering for acute illness or those with chronic illnesses or disabilities.

Question 8

Globalization

Answer 8

Health care providers have to make their services more accessible.

Question 9

Home care

Answer 9

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.

Question 10

Hospice

Answer 10

a system of family-centered care that allows patients to live and remain at home with comfort, independence, and dignity while easing the pains of terminal illness.

Question 11

Independent practice association (IPA)

Answer 11

The Managed Care Organization (MCO) contracts with physicians who usually are not members of groups and whose practices include fee-for-service and capitated patients.

Question 12

Integrated delivery networks (IDNs)

Answer 12

Part of larger health care systems; include a set of providers and service organized to deliver a continuum of care to a population of patients at a capitated cost in a particular setting.

Question 13

Managed Care

Answer 13

describes healthcare systems in which provider or health care system receives a predetermined capitated payment for each patient enrolled in the program.

Question 14

Medicaid

Answer 14

Federally funded, state-operated program that provides:

a. Health insurance to low-income families
b. Health assistance to low-income people with long-term care (LTC) disabilities
c. Supplemental coverage and LTC assistance to older adults and Medicare beneficiaries in nursing homes. Individual states determine eligibility.

Question 15

Medicare

Answer 15

A funded national health insurance program in the US for people 65 years and older.

a. Part A: provides basic protection for medical, surgical, and psychiatric care costs based on DRGs; also provides limited skilled nursing health care, hospice and home health care.
b. Part B: is a voluntary medical insurance; covers physician, certain other specified health professional services, and certain outpatient services.
c. Part C: a managed care provision that provides a choice of three insurance plans.
d. Part D: a voluntary Prescription Drug Improvement.

Question 16

Minimum data set (MDS)

Answer 16

a rich resource for nurses in determining the best interventions to support the health care needs of this growing population.

Question 17

Nursing Informatics

Answer 17

Uses information and technology to communicate, manage knowledge, mitigate error, and support decision-making.

Question 18

Nursing-sensitive outcomes

Answer 18

patient outcomes and select nursing workforce characteristics that are directly related to nursing care such as changes in patients’ symptom experiences, functional status, safety psychological distress, RN job satisfaction, total nursing hours per patient day, and costs.

Question 19

Patient-centered care - dimension 1

Answer 19

a. Respect Values, preferences, and expressed needs: - Respect the patient and treat them with dignity. Make sure the patient is informed and get to share in decisions about their care.

Question 20

Patient-centered care - dimension 2

Answer 20

b. Coordination and integration of care: reduce feelings of powerlessness, patients look for someone in charge and need to know how to call for help at all times.

Question 21

Patient-centered care - dimension 3

Answer 21

c. Information, communication, and education: Patients expect to receive accurate and timely information about their status, progress and prognosis. Patients and families need to be involved of major changes. Explain procedures clearly and let family members and patients know how to manage care on their own.

Question 22

Patient-centered care - dimension 4

Answer 22

d. Physical comfort: Provide comfort from pain management. Respond in timely manner for any and all needs, especially pain. Patients expect privacy and their cultural values respected. Help with doing daily activities and keep the environment clean.

Question 23

Patient-centered care - dimension 5

Answer 23

e. Emotional support and relief of fear and anxiety: Patients look to care providers to share fears and concerns. They need to understand the impact that illness will have on their ability to care for themselves. Patients worry about their ability to pay for their medical care, so find staff that will alleviate this worry.

Question 24

Patient-centered care - dimension 6

Answer 24

f. Involvement of family and friends: Respect and meet the needs of patients, family and friends. Patients have the right to determine whether friends or family members can be involved in decisions. Properly inform all parties about what to do or expect after discharge.

Question 25

Patient-centered care - dimension 7

Answer 25

g. Transition and continuity: Provide information about medications to take, physical limitations, dietary or treatment plans to follow, and danger signals for which to look after hospitalization or treatment. Patients expect to have their continuing health care needs met after discharge with well-coordinated services.

Question 26

Patient-centered care - dimension 8

Answer 26

h. Access to care: Patients want to get to hospitals and clinics easily without hassle; need to be able to find transportation when going to different locations; want to be able to schedule appointments at convenient times without problems; want to be able to see a specialist when a referral is made; expect to receive clear instructions on how to obtain referrals to other health care providers.

Question 27

Pay for performance

Answer 27

designed to promote quality, effective, and safe patient care by physicians and health care organization.

Question 28

Primary health care

Answer 28

focuses on improved health outcomes of an entire population. Includes primary care and health education, proper nutrition, maternal/child healthcare, family planning, immunizations, and control of diseases. Requires a collaboration among health care professionals, health care leaders, and community members.

Question 29

Professional standards review organizations (PSROs)

Answer 29

review the quality, quantity and cost of hospital care.

Question 30

Prospective payment system (PPS)

Answer 30

Established by Congress in 1983; eliminated cost-based reimbursement.

Question 31

Rehabilitation

Answer 31

restores a person to the fullest physical, mental, social, vocational, and economic potential possible.

Question 32

Resource utilization groups (RUGs)

Answer 32

Similar to DRG’s, these are used in long-term care.

Question 33

Respite care

Answer 33

a service that provides short term relief or “time off” for people providing home care to an ill, disabled, or frail older adult.

Question 34

Restorative care

Answer 34

to help individuals regain maximal functional status and enhance quality of life through promotion of independence and self-care.

Question 35

Skilled nursing facility

Answer 35

offers skilled care from a licensed nursing staff; includes administration of IV fluids, wound care, long-term ventilator management, and physical rehabilitation.

Question 36

Utilization review (UR) committees

Answer 36

medicare-qualified hospitals have physician supervised URs to review the admissions and to identify and eliminate overuse of diagnostic and treatment services ordered by physicians caring for patients on Medicare.

Question 37

Vulnerable populations

Answer 37

Children, women and older adults most threatened by urbanization.

Question 38

Work design

Answer 38

More services are available on nursing units, thus minimizing the need to transfer and transport patients across multiple diagnostic and treatment areas.