Specialty Care, Inpatient, Collaboration, Etc. Flashcards
(36 cards)
Value Based Purchasing
uses hospital quality metrics in five domains for reimbursement. Result in ‘pay for performance’
New Look of Primary Care
Patients want 24/7 access and low waits, this resulted in retail health movement / urgent care that offer many primary care services as well as the concierge practice movement.
Distinguish between different types of primary and specialty care practices
PCPs have broad knowledge, specialists focus on the management of specific conditions and/or body systems.
5 Elements of the primary medical home
Comprehensive care
Patient centered
Coordinated Care
Accessible Services
Quality and Safety
Define the patient-centered medical home model
provides health care that is relationship based with orientation towards the whole person, understanding and respect for unique needs / culture / values / preferences and supports patients in managing their own care with family as part of the care team.
Guidelines for improving quality of care and communication during transitions
Medication reconciliation, send clinical summary to PCP or to referral specialist, provide patient education and written discharge instructions
Define accessible services
In the context of the PCMH, it means shorter waiting times for urgent needs, enhanced in-person hours, around the clock access to member of the care team, and alternative communication methods such as email or texting.
Primary Care
General healthcare focusing on preventative and care for common medical issues as well as continuing care and coordination of specialty care.
Urgent Care
unscheduled provider care facility that provides a variety of primary and emergency care.
Outpatient specialty
Primary care is outpatient care, and outpatient specialists are providers in a specific speciality that provide care to patients outside the hospital
Inpatient Care
A patient who has been admitted to the hospital
Extend care facilities
Umbrella term for both skilled and non-skilled facilities.
Assisted living, retirement communities, memory-care units, and long-term care are all used for individuals with stable, chronic conditions with varying capacities to care for themselves. On the other hand, patients in skilled nursing facilities need skilled services, such as physical therapy or complex wound care. This is often the case after surgeries and other hospitalizations. Typically, patients do not reside in skilled nursing facilities. When patients have stabilized (or their insurance stops paying for therapy), they are transitioned to long-term, nonskilled care.
Best practices in urgent care for transitions of care
Ask patients who their PCP is, who their home care provider is, send a clinical summary of the visit to their PCP and home care provider, send summary to the ED is referred to the ED, always perform a medication reconciliation, provide patient with effective education and written discharge instructions
Best practices for urgent care in general
Operational excellence
patient experience
engaged, empowered employee culture
‘no wait, no waste, no hassle’. Be consumer focused and technologically saavy
Increasing need for NP in specialty care
Physician specialty shortage by 2025 and APRNs are growing faster than physicians
Scope of practice for NPs as defined by NCSBN
APRNs come in four roles and in at least 6 population foci.
CRNA - Anesthetist
CNM - Midwife
CNS - clinical specilaist
CNP - nurse practitioner
CNPs are educated and practice at an advanced level to provide care in a range of settings and in one of six patient populations - family, pediatric, internal medicine, geriatrics, women’s health
Difference between FNP and ACNP
Family nurse practitioners (FNPs) provide primary care to individuals across the lifespan while acute care nurse practitioners (ACNPs) provide care in hospital and other institutional settings for acute illness / disease management
Expansion of roles of the NP
Movement towards a APRN compact license. The consensus model to standardize licensure by 4 domains and/or population context, and specific specialties identified by professional organizations not the state.
NP role in post-acute and long-term acute care
Expand care and reach, can do non-skilled admissions, reduce readmission, setting and meeting of care goals, fill the gaps of fewer specialist physicians in PA/LTC care of older adults
Discuss the role of the NP in co-management of care
as the primary care provider, it’s your job to make sure that all the patient’s needs are managed one way or another, which is the foundation for the patient medical home model. Within your practice, a team-based care approach will also ensure effective communication between all clinicians, staff, patients, and families.
The PCP should be the central hub to coordinate care and information and request / compile information from specialists
Explain how to co-manage patients requiring expertise of specialty practice
Explain the reason / need for the specialists and the urgency (if applicable). Select an appropriate specialist, communicate to the specialist the reason for the consult with a consult letter / introduction, use a tracking system for follow-up, use a co-management agreement with the specialist that details how the care will be managed
Review key elements of SOAP note
Subjective (patient tells you)
Objective (findings of exam, tests)
Assessment (possible diagnosis, differentials)
Plan (specific actions and goals)
SOAP note should tell a story and flow into the assessment. Be careful with diagnosis as they are labels. The plan should be specific not general.
Process of pre-surgical clearance
Process to identify previously undiagnosed disease or risk that could impact surgical care.
Low risk surgical procedures
cataracts removal, carpal tunnel surgery, breast biopsy, inguinal hernia repair
