Module 14: Patient Care Coordination and Education Flashcards
(58 cards)
1
Q
what contributes to the increase in healthcare costs
A
- lack of care coordination
- repeated diagnostic testing, multiple prescriptions, adverse medication interactions, unnecessary emergency department visits, hospital readmissions
2
Q
care coordination
A
deliberate organization of pt care activities between two or more participants involved in a patient’s care to facilitate the appropriate delivery of healthcare services
3
Q
Affordable Care Act (ACA)
A
- signed 2010
- increased quality, availability, and affordability of private and public health insurance
4
Q
are chronic illnesses increases
A
- yes
- expected increase of over 1 percent each year
5
Q
patient-centered medical home (PCMH)
A
- pt is focus
- use holistic healthcare approach
- intended to improve effectiveness of primary care
6
Q
accountable care organization (ACO)
A
- pt is focus
- use holistic healthcare approach
- association of providers and third-party payers that assume responsibilities for specific populations and held accountable financially and quality-wise for members’ health
7
Q
holistic health care
A
- comprehensive
- considers physical, emotional, social, economic, and spiritual needs of person
8
Q
primary care provider (PCP)
A
- first provider pt seeks care from
- preventative care services
- can be family practitioners, internal medicine, doctors of osteopathy, pediatricians
9
Q
specialist
A
- provider that diagnoses and treats conditions that require specific area of expertise
- pt referred to by PCP
10
Q
physician assistant (PA)
A
- similar to physicians
- license to practice medicine when supervised by MD
- conduct physical exams, provide preventative care, prescribe diagnostic tests, assist with surgical procedures, diagnose illnesses, prescribe medicine
11
Q
advanced practice nurses
A
- more education and experience than RN
- similar tasks as PA
- clinical nurse specialist, nurse anesthetist, nurse practitioner, nurse midwife
12
Q
registered nurse (RN)
A
- licensed by state
- associate or bachelors in nursing
- oversee case management of pt with chronic conditions
13
Q
practical nurse (PN)
A
- vocational nurse
- licensed by state
- 1 yr training
- triage phone calls, administer meds, assist with clinical duties
14
Q
pharmacist
A
- prepare and dispense medications
- knowledgeable on meds and combos
- educate pts
15
Q
dentist
A
- diagnose and treat teeth and mouth issues
- educate on disease prevention of mouth
16
Q
occupational therapist
A
- assist and educate pt on performing tasks after [physical, mental, or developmental disability
17
Q
physical therapist
A
- assess pt pain, strength, mobility
18
Q
speech therapist
A
- pts having problems with speech and swallowing due to injury, cancer, or stroke
- work toward improving, regaining, and maintaining ability to communicate, chew, and swallow
19
Q
psychiatrist
A
- MD who diagnose, prescribe, and treat mental, behavioral, and emotional disorders
20
Q
psychologist
A
- not MD
- doctor of psychology or philosophy
- work with pts having mental health challenges
21
Q
social workers
A
- assist pt and families in times of transition or crisis
- clinical or hospital setting
- physical, emotional, and financial issues related to injury or illness
- coordinate additional services (transport, housing, meals, financial resources, hospice)
22
Q
registered dietician nutritionist (RDN)
A
- expert in diet and nutrition
- educate pt on connection between chronic disease and poor nutrition
- assist with meal planning
23
Q
examples of support staff
A
- clinic coordinator
- medical administrative assistant
- clinical medical assistant
- medical records specialist
- medical billing specialist
- financial counselor
- scheduler
24
Q
key to achieving full participation of pt and their families
A
good communication
25
successful care coordination results in what
- improved pt outcome
- increased pt satisfaction with care
- fewer hospitalizations
- less testing
- fewer treatments
- decreased healthcare costs
26
Institute for Health Care Improvement (IHI) goals
- aka triple aim initiative
- improve experience of care
- improve health of populations
- reduce costs of healthcare
27
ACA goals
- expand health insurance coverage
- shift focus of healthcare delivery system from treatment to prevention
- reduce costs and improve efficiency of healthcare
28
five core functions of PCMH
- comprehensive care: cares for all pts needs
- patient-centered: pt and family are core members of team
- coordinated care: all services are overseen by provider-directed medical practice
- accessible services: provide tools through pt portal
- quality and safety: evidence-based medicine
29
how to PCMH save money
- reducing emergency department visits and hospital admissions/readmissions
- provide overall improvement in pt health
30
how is ACO different from PCMH
- ACO includes many practices within one organizing entity (many providers, hospitals, specialty clinics)
- ACO focused on more than the pts in one practice, relationship to community
- ACO emphasis on public health issues to prevent illness
- ACO may have outreach programs available to anyone
31
successful transitional care
- appropriate coordination and continued quality in healthcare as patient moves from one care setting to another
- communication between providers
32
nurse in transitional care model
- communicates with provider's office
- accompanies pt to follow-up visits
- educates pt on managing their own care
- encourages pt to take active role in maintaining health
33
when does planning for pt discharge begin
- upon admission to critical care facility
34
what should you make sure is available to the provider before a scheduled appointment
- all reports from the hospital stay
35
what should each workday start with
- team meeting to go over pt list for the day
36
determinants of health
- social factors
- health services
- individual behaviors
- genetic factors
- accessibility and affordability of care
- policymaking
37
conditions that have strong biological or genetic connections
- sickle cell anemia
- hemophilia
- cystic fibrosis
- heart disease
- cancer
38
social determinants
- education
- employment opportunities
- fresh foods in grocery stores
- minimal exposure to crime and violence
- adequate transportation
- exposure to mass media/emerging technologies
39
physical determinants
- weather/climate change
- housing/neighborhoods
- work sites
- recreational settings
- exposure to toxic substances and physical hazards
40
Medicare Access and CHIP Reauthorization Act (MACRA)
- April 16, 2015
- replaces Medicare reimbursement schedule with pay-for-performance prgam
41
two new payment tracks available through MACRA
- Merit-Based Incentive Payment System (MIPS)
- Advanced Alternative Payment Models (APM)
- determine what Medicare will reimburse providers
42
four performance categories for Medicare reimbursement
- quality
- cost/resource use
- clinical practice improvement activities
- advancing care information
43
areas tracked by MACRA
- using claims data to calculate population-based measures
- promotion of EHR use
- achieving health equity
- expanded practice access
44
things to establish in pt chart during pre-visit planning
- due dates of preventative testing
- due dates of immunizations
- due dates of pt care management items
- expired or soon-to-be-expired prescriptions
45
CMA responsibilities during visit
- escort to exam room
- get ht and wt
- vitals
- pt intake questions
- medication reconciliation
- documenting
- discuss diagnosis or treatment with pt
46
how to achieve pt compliance
- develop rapport with pt to make them feel involved
- effective communication
- establish trust
47
auditory learning
- hearing info
- provide info verbally
48
kinesthetic learning
- movement or performing task
- pt sees action and then performs it themselves
49
visual learning
- reading info
- diagrams or graphics
50
what should you always ask the pt after educating them
- ask for feedback
- evaluates effectiveness of teaching
51
how to evaluate pt understanding
- restating
- repeating
- rephrasing
52
barriers to learning can be
- physical
- developmental
53
how to teach children
- speak at appropriate grade level
- do not stand over child
- have child repeat info or demonstrate skill
- educate parent
54
how to teach pt with visual impairments
- large-print or Braille resource
- demonstration by handling materials
55
how to teach pt with hearing loss
- speak face-to-face
- have pt repeat info
- provide written material
56
how to teach pt with language barriers
- material available in patient's primary language
- speak to pt not translator
- look for nonverbal clues
57
continuity of care
continuation of care smoothly from one provider to another so pt receives most benefit and no interruption to care
58
best way to promote compliance
communication
