Health Care Delivery Systems

Created by

Rose

Cards (45)

Health care delivery systems
Incorporate interactions between health care providers and clients within the constraints of financing mechanisms and regulatory agencies
Components of health care systems
Clients who participate
Settings in which health care takes place
Agencies that regulate health care
Mechanisms that provide financial support
Most nurses deliver care within the context of health care systems
As health care systems continue to become more business-driven and less service-oriented 
The challenge to nursing today is to retain its caring values while practicing within a cost-containment structure
Participants in health care systems
Unlicensed providers (assistive personnel)
Consumers (clients)
Licensed providers (Registered nurses, Licensed practical nurses, Advanced practice nurses, Medical doctors, Pharmacists, Dentists, Dietitians, Physical/respiratory/occupational therapists)
Settings of health care
Hospitals
Homes
Skilled-nursing, assisted-living, and extended-care facilities
Community/health departments
Adult day care centers
Schools
Hospices
Providers' offices
Ambulatory care clinics
Occupational health clinics
Stand-alone surgical centers
Urgent care centers
Complementary therapy centers
Urgent and emergent care centers
Public health agencies
Crisis centers
Diagnostic centers
Specialized services (dialysis, oncology, rehabilitation, burn) centers
Regulatory agencies 
U.S. Department of Health and Human Services
U.S. Food and Drug Administration (FDA)
State licensing boards
The Joint Commission
Professional Standards Review Organizations
Utilization review committees
Public federally funded health care financing programs
Medicare (Part A, Part B, Part C, Part D)
Medicaid
Patient Protection and Affordable Care Act
State Children's Health Insurance Program
Private health care financing plans
Traditional insurance
Managed care organizations (MCOs)
Preferred provider organizations (PPOs)
Exclusive provider organizations (EPOs)
Long-term care insurance
Social determinants of health (SDOH)
Neighborhood and built environment
Social and community context
Economic stability
Food and nutrition
Health and healthcare
Education
The family unit plays an important role in an individual's health and wellbeing
Role of the nurse
Advocate for improved access to health care services
Perform individual risk assessments
Conduct cultural and environmental assessments
Identify systems that support access to healthcare
Identify and discuss ethical issues
Participate in policy development
Primary health care system
Makes comprehensive health care available and in close proximity to those who need it, with flexible cost to accommodate income variations
Barriers to health care
Inadequate health care insurance
Inability to pay for health care services
Language barriers
Cultural barriers
Lack of health care providers in a community
Geographic isolation
Lack of transportation
Distance of travel
Provider office wait times
Interventions by the nurse
Primary prevention (advocate for availability of services, provide education)
Secondary prevention (perform assessments, implement screening)
Tertiary prevention (assist in obtaining transportation, provide insurance resources)
Levels of health care
Preventive (education, risk reduction)
Primary (health promotion, partnership with clients)
Secondary (diagnosis and treatment of acute illness/injury)
Tertiary (specialized and highly technical care)
Restorative (follow-up care for restoring health)
Continuing (long-term or chronic care)
The level of care depends on the needs of the client
Licensed and unlicensed health care personnel work in every level of care
Regulatory agencies help ensure the quality and quantity of health care and the protection of health care consumers
Health care finance influences the quality and type of care by setting parameters for cost containment
Types of health care
Primary
Secondary
Tertiary
Restorative
Continuing
Primary health care 
Emphasizes health promotion and disease control, often delivered during office visits, includes screenings
Primary health care 
Obesity screenings during routine office visits
Secondary health care 
Diagnosis and treatment of acute injury or illness
Secondary health care 
Diagnostic centers
Tertiary health care 
Provision of specialized and highly technical care
Tertiary health care 
Intensive care unit
Oncology treatment center
Burn center
Restorative health care 
Intermediate follow-up care for restoring health and promoting self-care
Restorative health care 
Home health care
Rehabilitation facilities
Skilled nursing facilities
Continuing health care 
Addresses long-term or chronic health care needs over a period of time
Continuing health care 
End-of-life care
Palliative care
Hospice
Adult day care
Assisted living
In-home respite care
The level of care depends on 
The needs of the client
Health care personnel 
Licensed and unlicensed work in every level of care
Settings for secondary and tertiary care
Usually within a hospital or specific facility
Settings for other levels of care
Vary
Regulatory agencies 
Help ensure the quality and quantity of health care and the protection of health care consumers
Health care finance 
Influences the quality and type of care by setting parameters for cost containment and reimbursement
Quality and Safety Education for Nurses (QSEN) assists nursing programs in preparing nurses to provide safe, high-quality care
Safety 
The minimization of risk factors that could cause injury or harm while promoting high-quality care and maintaining a secure environment for clients, self, and others
Patient-Centered Care 
The provision of caring and compassionate, culturally sensitive care that addresses clients' physiological, psychological, sociological, spiritual, and cultural needs, preferences, and values. The client is included in the decision-making process.