The Health Care Delivery System Mechanism for providing services that meet the health-related needs of individuals. major focus on quality and patient safety Nursing is a major component of the U.S. health care delivery system. Quality/safety ◦ Evidenced based practice (EBP) QSEN Standards NLN Standards Core Measures ◦ Safety standards (JCAHO) Leapfrog group ◦ Emergency preparedness Triage is the key ◦ Scientific and technical advancements Robots, machines to do nursing work ◦ Hospitalists programs Work with the nursing staff, part of hospital—not independent ◦ Information technology Improves nursing quality Reduces costs Enhances work flow Allows for use of best practices ◦ Demand for quality care Public well informed….or misinformed Individual appraises nursing actions Unit outcomes . Federal Level ◦ U.S. Department of Health and Human Services (DHHS) State Level ◦ Department of Health Local Level Health Units ◦ ◦ ◦ ◦ ◦ Communicable disease control Health records maintenance Individual health services Environmental health and safety Public health education Hospitals Extended care facilities Home health agencies Hospices Outpatient settings . Schools Industrial clinics Managed care organizations Community nursing centers Rural primary care hospitals . Private Insurance Managed Care ◦ Primary care providers ◦ Health Maintenance Organizations (HMOs) ◦ Preferred Provider Organizations (PPOs) Company Self pay policy ◦ Alegent system . Federal Government Insurance Plans ◦ Social Security Act 1965 ◦ Medicare Medicaid ◦ Regulated by Centers for Medicare & Medicaid Services (CMS) Medicare ◦ ◦ ◦ ◦ Individuals over age 65 Public funding Permanently disabled individuals Individuals with end-stage renal disease . Medicaid ◦ ◦ ◦ ◦ ◦ ◦ Medically indigent Determined by federal and state governments Inpatient and outpatient hospital services Physician services Laboratory services Rural health clinic services Cost Access Quality . Four major factors increase the cost of health care ◦ ◦ ◦ ◦ An over supply of specialized providers A surplus of hospital beds The passive role assumed by most consumers Inequitable financing of services Prohibitive costs for employer to provide Inability to obtain individual insurance Cultural barriers Persons with preexisting conditions Shortages of health care providers Limited access to ancillary services . Estimated that 30% to 40% of diagnostic/medical procedures performed in U.S. are unnecessary Inappropriate use of resources U.S. per capita healthcare spending= $8,000 ◦ (2008 stats) Institute of Medicine (IOM) report ◦ Change recommendations for nursing/healthcare access BSN at bedside Ability to share patient info across all points of entry EPIC . Positive Perception of Nurses ◦ Nurses are persistently seen as having the highest standards of honesty and ethics. ◦ The public believes that if nurses were allowed to use their skills, they would significantly enhance quality and reduce costs. Nursing shortage Loss of control over health care decisions Decreased use of hospitals Changing practice settings Ethical issues Vulnerable populations ◦ Children, elderly, chronic disease. homeless Nursing Shortage: By 2020 the workforce is forecast to be 20% below requirements. ◦ Fewer people entering the profession ◦ Aging of the nursing population ◦ Other career options offering greater remuneration Loss of Control ◦ Consumers express a loss of personal control within the health care system. ◦ Some feel terrorized by the system. ◦ Many American workers state that their greatest concern is the possible loss of health care coverage. Decreased use of hospitals ◦ ◦ ◦ ◦ ◦ Shorter lengths of stay Technologic advances Greater availability of outpatient facilities More services available in outpatient settings Expectations/demands of third-party payers . Changing Practice Settings ◦ Most nurses currently practice in hospitals and will continue to do so in the future. ◦ There is an ever-increasing need for expanded services and settings. ◦ Larger numbers of nurses will be needed for primary care, public health, extended care facilities, and the home setting. . Ethical Issues ◦ At present, citizens’ needs are greater than available resources. ◦ The United States is struggling with major ethical conflicts over allocation of scarce resources versus compassionate quality care. . Discharge planning ◦ Assess needs, coordinate referrals, length of stay, evaluate progress, arrange for equipment /supplies Social services ◦ Assess needs, assist with application for aid, evaluate discharge environment and care giver support Utilization review ◦ Track length of stay, review resources used, evaluate level of care and placement Facilitate high quality patient care Encourage high patient satisfaction Promote better outcomes . Assign workers Supervise care givers Know practice act for state, job descriptions Are accountable Evaluate if delegation was successful . 227 Nurses continue to advocate for ethical distribution of resources as health care reform progresses. Nursing’s Agenda for the Future is a plan that focuses on strategies to improve professional conditions for nurses and quality of health care by 2010. . 229 Major overhaul of healthcare system ◦ ‘donut hole’ protection for seniors- rebate to supplement drug coverage max ◦ Eliminating pre existing restrictions ◦ Increasing age to 26 to be covered on parent’s plan ◦ Eliminating insurance dropping ◦ Increased tax on tanning (tax goes to cancer research) ◦ healthcare.gov website transparency ◦ New food labeling Source: Nursing Now! 2010 Tax credits for small business providing insurance to <50 employees Reduced out of pocket expenses for employees 2 year temporary credit for research into new therapies. . Eliminating pre existing for adults Eliminating increased ins. Payment based on gender or health status No lifetime caps Increased payment for medicare to rural hospitals Options of coverage thru state run exchanges . Preventative care with no copay Leadership and planning Delivery systems Legislation/ ◦ Regulation policy Professional/nursing culture Recruitment/ retention Economic value Work environment Public relations/ communication Education Diversity . Standards of care Advanced practice Public versus private programs Public health Community health School nursing Long-term care