Chapter 3 Health Care Delivery System: Key Terms

Question 1

Acute Care

Answer 1

Pattern of health care in which a patient is treated for an acute episode of illness, possibly an accident or other trauma, or during recovery from surgery

Question 2

Adult Day Care Centers

Answer 2

Facility for the supervised care of older adults, providing activities such as meals and socialization during specified day hours

Question 3

Assisted Living

Answer 3

Residential living facilities in which each resident has his or her own room and shares dining and social activity areas

Question 4

Capitation

Answer 4

Payment mechanism in which a provider (health care network) receives a fixed amount or payment per erollee

Question 5

Diagnosis-Related Groups (DRG’s)

Answer 5

Group of patients classified to establish a mechanism for health care reimbursement based on length of stay; classification is based on the following variables; primary and secondary diagnosis, comorbidities, primary and secondary procedures, and age

Question 6

Discharge Planning

Answer 6

Activities directed toward identifying future proposed therapy and the need for additional resources before and after returning home

Question 7

Extended Care Facility

Answer 7

An institution devoted to providing medical, nursing, or custodial care for an individual over a prolonged period, such as during the course of a chronic disease or during rehabilitation phase after an acute illness

Question 8

Globalization

Answer 8

Worldwide scope or application

Question 9

Home Care

Answer 9

Health services provided in the patient’s place of residence for the purpose of promoting, maintaining, or restoring health or minimizing the effects of illness and disability

Question 10

Hospice

Answer 10

System of family-centered care designed to help terminally ill persons be comfortable and maintain a satisfactory life-style throughout the terminal phase of their illness

Question 11

Integrated Delivery Networks (IDNs)

Answer 11

Set of providers and services organized to deliver a coordinated continuum of care to the population of patients served at a capitated cost

Question 12

Managed Care

Answer 12

Health care system in which there is administrative control over primary health care services. Redundant facilities and services are eliminated, and costs are reduced. Preventative care and health education are emphasized

Question 13

Medicaid

Answer 13

State medical assistance to people with low incomes, based on Title XIX of the Social Security Act. States receive matching federal funds to provide medical care and services to people meeting categorical and income requirements

Question 14

Medicare

Answer 14

Federally funded national health insurance program in the United States for people over the age of 65. The program is administered in two parts. Part A provides basic protection against costs of medical, surgical, and psychiatric hospital care. Part B is a voluntary medical insurance program financed in part from premiums contributed by people enrolled in the program

Question 15

Minimum Data Set (MDS)

Answer 15

Required by the Omnibus Budget Reconciliation Act of 1987, the MDS is a uniform data set established by the Department of Health and Human services. The MDS serves as the framework for any state-specified assessment instruments used to develop a written and comprehensive plan of care for newly admitted residents of nursing facilities

Question 16

Nursing-Sensitive Outcomes

Answer 16

Outcomes that are within the scope of nursing practice; consequences or effects of nursing interventions that result in changes in the patient’s symptoms, functional status, safety, psychological distress, or costs

Question 17

Patient-Centered Care

Answer 17

Concept to improve work efficiency by changing the way patient care is delivered