Healthcare Delivery System

• Healthcare services are often described in terms of how they are correlated with levels of disease prevention: (a)primary prevention, which consists of health promotion and illness prevention; (b) secondary prevention, which consists of diagnosis and treatment; and (c) tertiary prevention, which consists of rehabilitation, health restoration, and palliative care
• Primary prevention is health promotion and illness prevention.
• The World Health Organization (WHO) developed a project called Healthy People.
• The U.S. Department of Health and Human Services (n.d.) project that evolved from the original work is called Healthy People 2020.
• The five goals of Healthy People 2030 are: (5) Engage leadership, key constituents, and the public across multiple sectors to take action and design policies that improve the health and well-being.
• Primary prevention programs address areas such as ade

  uate and proper nutrition, weight control and exercise, and stress reduction
• Health promotion activities empha ize the important role clients play in maintaining their own health and encourage them to maintain the highest level of wellness they can achieve
• Illness prevention programs may be directed at the client or the community and involve such practices as providing immunizations, identifying risk factors for ill

  esses, and helping individuals take measures to prevent these illnesses from occurring
• Tertiary Prevention: Rehabilitation, Health Restoration, and Palliative Care The goal of tertiary prevention is to help individuals move to their previous level of health (i.e., to their previ

  us capabilities) or to the highest level they are capable of given their current health status
• Rehabilitative care emphasizes the importance of assisting clients to func ion adequately in the physical, mental, social, economic, and vocational areas of their lives
• Government (official) agencies are established at the local, state, and federal levels to provide public health services
• Local health departments are respon ible for developing programs to meet the health needs of the individuals, providing the necessary nursing and other staff and facilities to carry out these programs, con inually evaluating the effectiveness of the programs, and monitoring changing needs
• Center. The Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, administers a broad program related to surveillance of diseases and behaviors that lead to disease and disability
• CDC also publishes recommendations about the prevention and control of infections and administers a national health program
• Public Health Service of the U.S. Department of Health and Human Services is an official agency at the federal level. Its functions include conducting research and providing training in the health field, assisting com

  unities in planning and developing health facilities, and assisting states and local communities through financing and provision of trained personnel
• Clients usually go to a physician’s office for routine health screening, illness diagnosis, and treat

  ent. Individuals seek consultation from physicians when they are experiencing symptoms of illness or when a sig

  ificant other considers the individual to be ill
• Ambulatory care centers, one type of outpatient setting, are used in many communities
• Ambulatory Care Centers - These centers offer two advantages: They permit the client to live at home while obtaining necessary healthcare, and they free up costly hospital beds for seriously ill clients
• The term ambulatory care center has replaced the term clinic in many places
• The industrial (occupational) clinic is gaining importance as a setting for employee healthcare
• Hospitals can be classified according to their ownership or control as governmental (public) or nongovernmental (private
• An acute care hospital provides assistance to clients whose illness and need for hospitalization are relatively short term, for example, several days
• Hospitals that provide a significant level of care to low-income, uninsured, and vulnerable populations are referred to as safety-net hospitals
• Subacute care is a variation of inpatient care designed for someone who has an acute illness, injury, or exacerbation of a disease process
• Sub

  cute care may be delivered in a long-term care facility, skilled nursing facility, or long-term care hospital and often lasts 20–90 days
• Extended care facilities, formerly called nursing homes, are now often multilevel campuses that include inde

  endent living quarters for older adults, assisted living facilities, skilled nursing facilities (intermediate care), and extended care (long-term care) facilities that provide levels of personal care for those who are chronically ill or are unable to care for themselves without assistance
• Because clients are being discharged earlier from acute care hospitals, some clients may still require supplemental care in a skilled nursing or extended care facility before they return home
• Retirement or assisted living centers consist of separate houses, condominiums, or apartments for residents. Resi

  ents live relatively independently; however, many of these facilities offer meals, laundry services, nursing care, transportation, and social activities
• Rehabilitation centers usually are independent community centers or special units
• Rehabilitation centers play an important role in assisting clients to restore their health and recuperate
• Rural primary care hospitals were created as a result of the 1987 Omnibus Budget Reconciliation Act to provide emergency care to clients in rural areas. In
• Rural primary care hospitals were created as a result of the 1987 Omnibus Budget Reconciliation Act to provide emergency care to clients in rural areas
• In 1997, the Bal nced Budget Act authorized the Medicare Rural Hospital Flexibility Program in order to continue to make avail ble primary care access and improve emergency care for rural residents
• Rural Care - NPs are particularly suited to these roles
• The hospice movement sub umes a variety of services given to clients who are terminally ill, their families, and support individuals
• The central concept of the hospice movement, as distinct from the acute care model, is not saving life but improving or maintaining the quality of life until death
• Hospice nurses serve primarily as case managers and supervise the deliv ry of direct care by other members of the team
• Crisis centers provide emergency services to clients expe iencing life crises
• Crisis Centers - These centers may operate out of a hospital or in the community, and most provide 24-hour telephone service. Some also provide direct counseling to individuals at the center or in their homes
• Crisis Centers - The primary purpose of the center is to help individuals cope with an immediate crisis and then provide guidance and support for long-term therapy