Health Care Institutions - PDF Free Download

Chapter 10 Health Care Institutions Slide Show developed by: Richard C. Krejci, Ph.D. Professor of Public Health Columbia College 4.9.15

Key Questions What institutions make up the Healthcare System? Observation vs. inpatient http://www.nbcnews.com/video/nightly-news/54026469/#54026469 What types of inpatient facilities exist in the United States? What types of outpatient facilities exist in the United States?

Questions What do we mean by quality of healthcare services? How can health care be coordinated among the multiple institutions that provide health services? What types of healthcare delivery systems are being developed and how can they ensure the efficient coordination of health care services?

More Questions How can electronic medial records facilitate coordination of care and improve overall quality? How is technology being used to improve the quality of care? What mechanisms are being used to monitor and ensure the quality of health care? Can disclosure of medical errors contribute to the overall quality of health care?

Health Care Institutions - Nursing Home Care Fred ended his walk one day in the emergency room. He seemed confused about how to get home. "It looks like we are dealing with Alzheimer s, Fred s doctor told Fred s wife Sonya at their next appointment. Taking care of Fred at home was not easy. Home health aides and occasional weekend relief called "respite care" eased the burdens for a while. The new assisted living facilities looked attractive, but Fred s family just could not afford it. When Fred fell and broke his hip he required hospitalization for surgery. The hospital discharge planner arranged for a skilled nursing home for rehabilitation services. After a few weeks of rehabilitation the only alternative was long term or custodial care in a nursing home. The care at the nursing home was not what the family had expected. The staff did clean him up before the announced family visits but when the family arrived for an unannounced visit they were shocked to see Fred lying half naked in the wheelchair. The end came almost two years from the day they moved him permanently to the nursing home. Looking back the family asked, how can we do better to address the needs of Alzheimer s patients?

Inpatient The Two Major Types of Facilities Hospitals (General & Specialty) Skilled nursing and rehabilitation facilities Nursing homes Institutional hospices Outpatient Medical clinics Diagnostic testing clinics Treatment clinics

Hospitals Categorized by Funding Source and Financial Arrangement (~5000) Private non-profit For-profit (investor owned) 90% in the U.S. are non-profit Government Select groups (VA Hospitals) Institutional Some are affiliated with Medical Schools

Skilled Nursing and Rehabilitative SNRS Short term Services (SNRS) Specific goal of rehabilitation/recovery Nursing Homes (est.16,000 facilities with 1.5 million residents) Long term services Regulated by the State Provide dressing, feeding, & bathing services 85% are private non-profit

Respite Respite Care and Hospice Temporary care from primary care givers Hospice Life expectancy <6 months Provide comfort, emotional support, and palliation Institution or place of residence

Community Health Centers The Health Centers Consolidation Act of 1996 can be found under Section 330 of the Public Health Service Act Federal 330 grants are available For medically underserved areas (MUA) or medically underserved populations (MUP) Requirements all grantees must have: non-profit, public, or tax exempt status provisions for comprehensive primary health care services, referrals, and methods for access to follow-up care a governing board consisting of patients a plan in place to make financial adjustments to meet the needs of the population

What is Meant by Quality of Health Care Services? In what areas are assessments conducted? Structure Physical and organizational infrastructure Process Procedures and formal processes Outcomes Cure rates to complications

Characteristics of Healthcare Quality: National Committee for Quality Assurance Characteristic Meaning Examples How measured? Access and Service Access to needed care and good customer service Enough primary care physicians and specialists Satisfaction of patients in terms of problems obtaining care Patient satisfaction surveys. Patient grievances and follow-up, interviews with staff

Characteristics of Healthcare Quality: National Committee for Quality Assurance Characteristic Meaning Examples How measured? Qualified providers Personnel licensed and trained and patients satisfied with services System for checking credentials, sanctions Patient satisfaction with availability of providers for specialized care Presence of system for checking credentials Patient satisfaction surveys

Characteristics of Healthcare Quality: National Committee for Quality Assurance Characteristic Meaning Examples How measured? Staying healthy Quality of services that help people maintain good health and avoid illness Presence of guidelines for appropriate clinical services Evidence that patients are receiving appropriate screening tests Review of independently-verified clinical records Review of responses from patients

Characteristics of Healthcare Quality: National Committee for Quality Assurance Characteristic Meaning Examples How measured? Getting better Quality of services that help people recover from illness Presence of method for evaluating new procedures, drugs, and devices to ensure that patients have assess to the most up-todate care Providing specific services, such as smoking cessation Review of independentlyverified clinical records Interviews with staff

Characteristics of Healthcare Quality: National Committee for Quality Assurance Characteristic Meaning Examples How measured? Living with illness Quality of services that help people manage chronic illness Programs to assist patients to manage chronic conditions like asthma Review of independentlyverified clinical records Provision of specific services, such as eye examinations for diabetics Interviews with staff

How Can Health Care Be Coordinated Among the Multiple Institutions that Provide Healthcare Services? Goals of the Healthcare delivery system 1. Connect impatient and outpatient services 2. Provide short-term and long-term clinical services 3. Provide a coordinated system of care through the integration of the many different providers

What Types of Coordination of Care Are Needed & What Purposes Do They Serve? Coordination is sought between institutions and settings where care is delivered; it formally links institutions, services, and information There are four types of coordination: 1. Clinician patient relationship 2. Institutional coordination 3. Financial coordination 4. Coordination between health care and public health

Type of Coordination of Care, Intended Functions and Challenges with Implementation Type of Coordination Clinician-patient relationship Intended function Continuity as a mechanism for ensuring coordination Development of individual relationships built on knowledge and trust over extended periods of time Challenges with implementation Multiple clinicians involved in care Team rather than individual concept of primary care Frequent changes in insurance coverage require change in health professionals

Type of Coordination of Care, Intended Functions and Challenges with Implementation Type of Coordination Institutional Coordination Intended function Coordination of individual s information between institutions needed to inform individual clinical and administrative decision making Challenges with implementation Different structures and governance often lead to lack of coordination between inpatient facilities and between inpatient and outpatient facilities

Type of Coordination of Care, Intended Functions and Challenges with Implementation Type of Coordination Financial Coordination Intended function Implies that a patient has comprehensive coverage for services provided by the full range of Institutions Maximize the efficiency of the care received and to minimize the administrative effort required to manage the payment system Challenges with implementation Lack of comprehensive insurance coverage often means that essential services cannot be delivered or cannot be delivered at the most efficient or effective institutional site

Type of Coordination of Care, Intended Functions and Challenges with Implementation Type of Coordination Coordination between Health care and Public health Intended function Coordination of services between clinical care and public heath requires communication to ensure follow-up and to protect the health of others Challenges with implementation Lack of coordination of services between public health services and clinical care is often based on lack of Communication (technologies are needed)

What Types of Healthcare Delivery Systems Are Being Developed, and How Can They Help Ensure Coordination of Health Care? Kaiser Permanente Veterans Administration The Affordable Care Act has a large number of provisions that encourage demonstration projects for Medicare patients

What are the Potential Roles for a Connected (Interlinked) Electronic Health Information System? 1. Health information and data 2. Order entry/management 3. Decision support management 4. Electronic communication and connectivity 5. Patient support 6. Results management 7. Administrative processes 8. Reporting and population health

Technology in Medicine Traditionally dependent on the financial market Has not brought down the overall costs of health care. Treatment and prevention Advances in research Tracking the human genome has led to new diagnostic and therapeutic approaches Integrative medicine and health coaching (via telecommunication and internet) How do we pay for this? (next week- chapter 11)

What Mechanisms Are Being Used to Monitor and Ensure the Quality of Health Care in the U.S.? Accreditation of academic institutions Individual credentialing of health professionals Increasing requirements for continuing education, recertification, and maintenance of licensure Integrating financial compensation with quality of care through the use of pay-for-performance approaches

Mechanisms That Insure Quality of Health Care Hospital privileges and approval to perform specific procedures Accreditations of additional health care organizations including clinical practices Malpractice liability for doctors, nurses, and technicians (next slide) Disclosure of medical errors (~ 40K deaths/year)

Establishing Medical Malpractice Legal Concepts Under Negligence Law 1. Duty was owed 2. Duty was breached 3. The breach caused an injury 4. Damages occurred

Addressing a Medical Error Facts about the event Presence of error or systems failure Expression of regret Formal apology Recommendations from the Joint Commission on Health and Human Services 2001.

Can Disclosing Medical Errors Contribute to Quality of Care and Serve as an Alternative to Malpractice? Institutions are now integrating the disclosure process with other aspects of patient safety and risk management activities Provide support for the disclosure process, including educating clinicians Growing acceptance of disclosure as a way of addressing medical errors

Summary 1. The major health care institutions include both inpatient and outpatient facilities. 2. The health care delivery system includes hospitals; skilled nursing and rehabilitation services; nursing homes; respite care; hospice care; and community health centers. 3. The quality of health care services can be determined through structure, process, and outcome measures. 4. Advances in technology and communication have enhanced the overall quality of health care in America. 5. Taking a proactive and preventative approach is one of the key ways to minimize the risk of medical errors.