Chapter Two: The Healthcare Delivery System
IHCDTraditional Level of Healthcare
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In 2020, 30 million Americans did not have insurance
Level of Care vs Level of Prevention
○ Prevention describes the focus of health-related activities in a care setting
○ Care describes the scope of services and setting delivered by providers
Integrated Health Care Delivery
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Primary and Preventive Health Care Services
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A network of healthcare organizations that work together to proceed services to a population with
intended outcomes of better aligning resources, improving quality, and controlling costs
○ Came from US health care reform from fragmented costly care found in US
Two Types of IHCD
○ Economic imperatives
■ Combining financing with all providers
○ Patient Centered medical home
■ Strengths provider-patient relationship with coordinated care
■ A Patient's primary is the coordinator who enlists the help of other professionals
Primary Care (Health promotion)
○ Focuses on improved health outcomes for entre population
■ Diagnosis and Treatment of common illness
■ Management of Chronic Conditions
■ Prenatal/Well-baby care. Family planning
■ Home care
○ Preventative Care
■ Adult Screenings for BP, Cholesterol, Tobacco use, Cancer
■ Pediatric screenings for sensory, mental, and social deficits
■ Wellness visits, immunizations, diet counseling
■ Mental health counseling/ Crisis prevention
■ Legislation: seat belts, car seats, helmets
Secondary and Tertiary Care (Acute Care)
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Secondary Care
○ Provided by a specialist/agency on referral by a primary care provider
■ Required specialized knowledge/skill the provider doesn't have
Tertiary care
○ Specialized consultative care with a referral from secondary medical personnel
Hospitals
○ Secondary and tertiary
○ Comprehensive to patients who are acutely ill.
○ Evidenced-based practice guidelines and clinical protocols [Right Care/Time/Protocol]
Intensive Care
○ ICU / CCU
■ Patients receive close monitoring and intensive medical/nursing care.
Mental Health Facilities
○ ⅕ experience mental illness in a given year. 1/20 serious
■ Only 44.8% received mental health services in 2019
○ In and outpatient facilities
Discharge planning
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Chapter Two: The Healthcare Delivery System
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Restorative Care
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Coordinated interprofessional process that develops a plan for continued care after
discharge.
○ Involves 3 elements
■ Determining post-hospital location for patient (case manager/social worker)
■ Identify patient's needs (nurses/therapist/providers)
■ Begin the process of meeting patients' needs while admitted
○ Required discharge instruction topics
■ Medications, Followup care, Medication changes, dietary needs, follow up tests
Rural Hospitals
○ Oly 13% of physicians practice here, but 20% of the population lives here
○ CAH
■ 35 miles from another hospital/CAH must be 24/7 emergency, no more than 25
inpatient beds, >96 hours of average stay. Transferred to larger hospital
Help individuals regain maximal function/ enhance the quality of life through the promotion of
independence/self-care
Homecare
○ Provision of medically related services/equipment to patients in their homes for health
maintenance/education/illness prevention/ diagnosis and treatment/ rehab/ palliative care
○ Goal of patients achieving independence, Addresses recovery/stabilization of illness
○ Approves agencies receive reimbursement for services from gov programs or insurance
Rehabilitation
○ The process of enabling people with disabilities to reach and maintain the optimal
physical, sensory, psychological social functional levels
○ Aims at helping patients adjust to necessary changes and learn to function within the
limitations of their disease
Extended Care Facilities
○ Provides intermediate medical/nursing/custodial care for patients recovering from acute
illness or those with chronic illness/disabilities
○ Skilled Nursing Facility
■ Offers care form nursing staff
Continuing Care
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Services provided over a prolonged period.
○ For people who were never functionally independent or have terminal disease
Nursing Centers or Facilities
○ 24hr intermediate/custodial care,
○ Complete a RAI for each patient
■ Set of screening/clinical/functional status elements. Forms the foundation of a
comprehensive assessment for all residents that are Medicare/Medicaid certified
Assisted living
○ Long-term care setting with a home-like environment and greater autonomy
Respite care
○ Offers short-term relief by providing a new environment or time to relax from family
caregivers
Adult daycare
○ Allow caregivers to maintain their lifestyle and employment
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Chapter Two: The Healthcare Delivery System
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Palliative and hospice care
○ Palliative care
■ Holistic care approach to improve quality of life for life-threatening illness
○ Hospice
■ Care that allows patients to live with comfort/independence/dignity while easing
the pain of a terminal illness
Issues in Healthcare Delivery for Nurses
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Health care costs and quality
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Inpatient Prospective Payment System
○ Social Security Act system for payment for the operating cost of acute care under
medicare part A based on set rates.
■ Patient is categorized into DRG,
● Each DRG has a payment weight assigned to it. Hospital receives this
amount, no more, no less
Affordable Care Act
○ Tied payments to organizations offering Medicare Advantage plans to the quality of
ratings of the coverage they offer
Patient Satisfaction
○ HCAHPS survey
Nursing Shortage
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A shortage of RNs, expected to intensity as boomer age
Competency
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QSEN
Patient-Centered Care
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Care that is respectful of to patients needs, preferences, values, and ensures the patient guides
all decisions
Picker Institute 8 Principles of Patient Centered Care
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Fast access to reliable health care advice
Effective treatment delivered by trusted professionals
Continuity of care and smooth transitions
Involvement and support for family and carers
Clear information, communication, and support for self-care
Involvement in decisions and respect for preferences
Emotional support, empathy, and respect
Attention to physical and environmental needs
Magnet Recognition Program
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Nurse-sensitive outcomes
○ Patient outcomes that are directly related to nursing care
The Magnet Model 5 Components
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Transformational Leadership
Structural Empowerment,
Exemplary Professional Practice
New Knowledge, Innovation, and Improvements
Empirical Quality Results
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Chapter Two: The Healthcare Delivery System
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Technology in health care
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Telemedicine, Robots, 3D Printing, Biometrics, ERH
Health care disparities
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Differences in health care outcomes among population groups.
○ Related to race, ethnicity, gender, location, disability, and social determinants
■ Examples of social determinants: Safe housing, transportation, and
neighborhoods, Racism, discrimination, and violence, Education, job
opportunities, and income, Access to nutritious foods and physical activity
opportunities, Polluted air and water Language and literacy skills
4 Challenges Facing Nursing ANA
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Aging Boomer Generation
Shortage/Uneven distribution of physicians: increase of care nurses will need to provide
Accelerating rate of nurse retirements from aging workforce
Uncertainty of healthcare reform with every administration
Acronym in Chapter:
AHA
American Hospital Association
CAH:
Critical access hospitals
CCU
Critical Care Unit
DRG
Diagnosis-related group
ICU
Intensive care unit
IHCD:
Integrated healthcare delivery
IPPS
Inpatient Prospective Payment System
LOS
Length of stay
NDNQI
National Database of Nursing Quality Indicators
OASIS
Outcome and Assessment Information Set
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