Health Care Delivery and Community-Based Care

1. Health Care Delivery and Community-Based Care

2. Health Care Reform Began in 1980�s An attempt to manage rising health care costs Organizations established to pay for health care Influenced who provided care, how care was furnished, and who received compensation Referral criteria established

3. Current Trends Hospitalized clients are �sicker� and need more technological management Clients are discharged sooner and �sicker� Discharge Planning MUST start on admission Managing health instead of managing illness Health care is less service oriented and more business oriented

4. Why must nurses understand the health care delivery system and issues that affect how care is provided?

5. Health Care Cost Containment Regulatory approach: Professional Standards Review Organization (PRSO) Utilization Review (UR) Competitive approach: Prospective Payment System Diagnostic Related Groups (DRGs) Resource Utilization Groups (RUGs) Capitation Managed Care Medicaid Medicare

6. Managed Care Multidisciplinary Outcome oriented Research based Variance analysis Bids/competition Quality improvement ? Duplication ? fraud Work analysis and redesign Critical pathways Patient centered Team meeting

7. Levels of Health Care Preventive Primary Secondary Tertiary Restorative Continuing

8. Care Settings Preventive and Primary School health services Occupational health Physician�s offices Clinics Nursing centers Restorative Home health Rehabilitation centers Extended care facilities Secondary & Tertiary Hospitals/medical centers ED, Medical units, ICU Psychiatric facilities Rural hospitals Continuing Care Agencies on Aging Nursing facilities Assisted Living Adult day care centers Hospice

9. Issues in Health Care Delivery Competency Evidence-based practice Knowing clients Unlicensed assistive personnel Quality health care

10. Knowing Clients Thoroughly review client data before care Plan first interaction with client Be observant and thoughtful Use time with client to assess condition and ongoing needs Do not be afraid of the family Make rounds regularly on patient care unit Talk with colleagues who also know client

11. Client Centered Care Respect for client�s values, preferences, and expressed needs Coordination and integration of care Information, communication and education Physical comfort Emotional support and relief of fear and anxiety Involvement of family and friends Transition and continuity

12. Community-Based Care Focus moving from acute care settings to community based settings Focus on health promotion, illness prevention and restorative care Focus is congruent with holistic approach of nursing

13. Healthy Peoples Initiative (US Department of HHS�Public Health Service) Initially created to establish health and wellness goals for 2000 Healthy People 2010� revised and raised goals Overarching goals: Increase life expectancy and quality of life Eliminate health disparities Designed to improve health care delivery to the general public Population based programs http://www.healthypeople.gov

14. Levels of Health Services Population-based Clinical preventive Primary health care Secondary health care Tertiary health care

15. Public Health Nursing Focus Understanding needs of population or a group of individuals with common characteristics Achievement of healthy environment for all Monitor trends and patterns influencing incidence of disease, environmental health Entry level MSN

16. Community Health Nursing Merges knowledge of public health sciences with professional nursing theories Community care as a whole by focusing on sub-populations Skills needed: Advocacy Understanding concerns of the population Designing new systems in cooperation with other systems Entry level BSN

17. Community-Based Nursing Individual and family oriented Appreciates values of the community Goal: individual/family assume responsibility for their health care decisions Nurse must understand the interaction of all units while caring for the client and family in their natural environment

18. Vulnerable Populations Subpopulations likely to develop health problems Specific populations with a unique health care problem Vulnerable by virtue of being uninsured or underinsured May belong to one or more vulnerable group

19. Vulnerable Populations Groups: Living in poverty Elderly Homeless Living in abusive relationships Substance abusers Severely mentally ill New immigrants Problems Often experience poor outcomes Shorter life spans Higher morbidity Cumulative risks/ combination risk factors result in being more sensitive to adverse effects

20. Competencies for Community-Based Nursing Case manager Collaborator Educator Counselor Client advocate Change agent

21. Community Assessment Three components: Structure or locale People Social systems Must thoroughly examine each component Individual assessments are done after assessment of the community Assessment should not occur in isolation� take into account the environment and conditions of the client�s community

22. Changing the Client�s Health Understanding the client�s life is essential Bring together resources needed to improve continuity of care Decrease duplication of services and locate best services Establishing a strong, caring relationship with clients/families