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Health Care Delivery and CommunityBased Care

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Health care is less service oriented and more business oriented ... Establishing a strong, caring relationship with clients/families ... – PowerPoint PPT presentation

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Title: Health Care Delivery and CommunityBased Care


1
Health Care Delivery and Community-Based Care
2
Health Care Reform
  • Began in 1980s
  • 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
  • Physicians 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 clients 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
HHSPublic 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 clients community

22
Changing the Clients Health
  • Understanding the clients 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
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