How does managed care affect the economics of health care delivery? Decreases duplicate processes and redundant facilities

How does managed care affect the economics of health care delivery? Decreases duplicate processes and redundant facilities

rationale:
The corporatization of health care amalgamates the smaller health care operations into the larger organizations to decrease duplicate and redundant health care provisions. For example, one hospital would provide a high level of cardiac care, while another hospital would focus on oncology.What is meant by the term integrated health care delivery system (IHS)? A large health care system that can provide all needed services under one corporate umbrella

rationale:
As part of the corporatization of health care, the individual health care organizations are merging into systems to provide all needed services under one corporate umbrella. These are known as integrated health care delivery systems.Characteristics of clinical pathways include all of the following except: Being a nurse-centered orientation

rationale:
Clinical pathways help reduce expensive variations in care. Clinical pathways are interdisciplinary plans of care that outline the optimal sequencing and timing of interventions for clients with a particular diagnosis, procedure, or symptom.Patient-focused care is a recently developed term to describe: A nursing care delivery system

rationale:
Patient-focused care is another type of delivery system. The level of productivity is increased through centralization of functions (phlebotomy, diet instruction, respiratory therapy) on the unit under the direction of the RN and cross-training ancillary workers to do more than one function. The patient comes into contact with fewer people under this organizational framework.What are two tools that support case management? Clinical pathways and disease management

rationale:
Both of these tools support case management by coordination and delivery of high-quality care. Clinical pathways are interdisciplinary plans of care that outline the optimal sequencing and timing of interventions for clients with a particular diagnosis, procedure, or symptom.A delivery of nursing care organized around tasks is known as: Functional nursing

rationale:
Aides and vocational nurses/licensed practical nurses are allowed to perform functions such as administration of medication and treatments. This functional kind of nursing results in a fragmented, impersonal kind of care.A system in which a nurse plans and directs the care of clients over a 24-hour period is known as: Primary nursing

rationale:
In primary nursing the fragmentation between shifts and nurses is eliminated because one nurse is accountable for planning the care of the client around the clock.Which statement is true about the case management model of nursing care? It is based on previously defined client outcomes.

rationale:
Clinical pathways are a tool used to support case management and to define client outcomes.. These are interdisciplinary plans of care that outline the optimal sequencing and timing of interventions for clients with a particular diagnosis, procedure, or symptom to achieve a defined client outcome.What is the primary work environment of nurses who are case managers? All types of health care organizations, as well as organizations with health-related functions, hire case managers.

rationale:
The case managers work in all types of health care institutions. They may also work for insurance or utilization review companies or in health-related areas of various types of large businesses.Which statement is true about client classification systems? They provide historical data of the usage of nursing time, which is helpful when developing the department budget.

rationale:
A client classification or acuity system is used in many acute care hospitals to estimate the intensity of nursing care required to meet client needs.Which of the following best describes the concept of evidence-based practice? It provides for the use of recent research in current nursing practice.

rationale:
The IOM reported that it took 17 years for research to be reflected into daily practice. Evidence based practice is the use of the current best evidence to provide care and make decisions regarding client care.A client is admitted to the labor and delivery unit where she is assigned a registered nurse who will manage her care for the duration of her hospitalization. What type of nursing care delivery model is represented in this nursing unit? Primary care

rationale:
This is an example of primary care nursing, in which the RN is the principal or primary person to manage and coordinate the client’s care around the clock. Patient-focused care is an interdisciplinary approach to client care. Functional care is the provision of care by nursing and nursing ancillary staff rather than by an all-nursing staff as seen in primary care nursing. Case management is a model of care delivery in which an RN case manager coordinates and collaborates with other health services when a client has complicated health care needs, but the case manager may not be involved in the daily care activities of the client.Which type of nursing delivery models would be appropriate in a rural area that would require fewer numbers of registered nurses? Select all that apply. -Functional nursing
-Team nursing
-Patient-focused care

rationale:
When you have a limited number of RN’s, then functional nursing, team nursing, and patient-focused care are useful, because you can deliver quality care by using more ancillary staff. Primary care is usually 24-hour RN coverage, and transition care is where APRNs conduct assessments and—with physicians—design and coordinate patient care and discharge plans.The primary role of The Joint Commission (TJC) is: Ensuring medical facilities meet client safety guidelines

rationale:
The Joint Commission is the primary accrediting body for health care institutions. Its standards directly address client safety issues. Magnet status is approved by the American Nurses Association. TJC does not lobby Medicare/Medicaid issues. The CDC would be the agency that maintains standards regarding infection control for hospital compliance.The Joint Commission publishes a Sentinel event alert every month. Which of the following is the best example of a sentinel event? Code Pink is called after a newborn is discovered missing from the nursery.

rationale:
A sentinel event is an unexpected occurrence involving death or loss of limb or function. Examples of sentinel events include serious medication errors, significant drug reactions, surgery performed on the wrong body site, blood transfusion reactions, and infant abductions.The technique used to identify the factors involved in an error is called: A root cause analysis

rationale:
When an error is analyzed, the primary causes need to be determined so that a workable and effective solution can be developed. A root cause analysis is such a process designed to investigate and categorize the root cause of the event.The person known for emphasizing the Pareto principle (80/20 rule) leading to the idea of total quality management is: Joseph Juran

rationale:
Joseph Juran is one of the forefathers of quality initiatives. He stressed the meaning of the Pareto principle and how it applies to improving quality in all organizations.The Joint Commission mandates the use of continuous quality improvement and measurement of specific quality outcomes, including clients admitted with: Community-acquired pneumonia and congestive heart failure

rationale:
TJC mandates outcome measures for clients admitted with a diagnosis of acute MI, congestive heart failure, community-acquired pneumonia, surgical infection prophylaxis, pregnancy-related conditions, and deep vein thrombosis.The primary barrier to the implementation of quality improvement processes is: Expense

rationale:
A primary barrier to implementing effective quality improvement programs is the cost. The cost of providing health care has greatly increased over the past few decades. However, through quality improvement measures, overall health care costs can be reduced.The primary goal of the continuous quality improvement process of Six Sigma is to: Diminish misuse of processes

rationale:
The primary goal of Six Sigma is to increase profits by improving standard operating procedures, reducing errors, and decreasing misuse of the system.During the define phase of the define-measure-analyze-improve-control (DMAIC) process, the team members: Identify the stakeholders

rationale:
In the define phase, a charter is developed; goals, team leaders, membership, and team roles and responsibilities are identified; and the stakeholders affected by the process are identified.To become credentialed as a Certified Professional in Healthcare Quality, you must: Take an exam

rationale:
To become a CPHQ, you must take and pass an examination. Only about 75% of those who test actually become certified.Which statement is true about client classification systems? The systems provide historical data of the usage of nursing time, which is helpful when developing the department budget.

rationale:
A client classification or acuity system is used in many acute care hospitals to estimate the intensity of nursing care required to meet client needs. It is not a formula for unit staffing.The continuous quality improvement (CQI) committee has performed a retrospective chart audit to investigate whether outcomes recorded in each nursing care plan are client-centered and written in behavioral terms. The expected standard is 98% compliance. The sample size was 200. Results showed that 180 charts met the standard. What assessment can be made? The standard was not met. An action plan should be developed.

rationale:
A threshold, or cutoff point, is determined for each indicator. This example represents a 90% compliance rate, but the threshold was set at 98%.Which of the following statements are true about continuous quality improvement? Select all that apply. -The accountability for quality is vested in the individual nurse
-Quality standards must incorporate the expectations of clients and their families.providing direct client care.
-Systems within the hospital must be reviewed to determine how care can be enhanced.

rationale:
This approach emphasizes continually looking for opportunities to improve. CQI looks not only at what the nurse does in the pursuit of quality but also at how the systems of the units in the hospital can be improved to provide better care at lower cost.What is the definition of nursing informatics? It is the activities focused on collecting, processing, and analyzing nursing data electronically to support nursing practice and knowledge.

rationale:
The ANA has defined informatics as “the activities involved in identifying, naming, organizing, grouping, collecting, processing, analyzing, storing, retrieving or managing data and information.”The nurse understands that a collection of various information technology applications that provides a centralized repository of information related to client care across distributed locations is called: A clinical information system (CIS)

rationale:
A clinical information system (CIS) is a repository that also encodes the status of decisions, actions underway for those decisions, and relevant information that can help in performing those actions. The database could also hold other information about the client, including genetic, environmental, and social contexts. Essentially, the CIS uses the computer to provide and store information and data about a client from departments that are client-focused or departmental-focused.What are examples of regulatory agencies that will affect health care policy with regard to informatics? Health Insurance Portability and Accountability Act (HIPAA)

rationale:
The Joint Commission (TJC) and the Health Insurance Portability and Accountability Act (HIPAA) are two regulatory and governmental agencies instituting health care policy.What is the importance of using classification systems for nursing nomenclature to describe nursing practice? To assist the quality control team to survey and gather data that will reflect the acuity classification of clients

rationale:
Nursing nomenclatures offer a recognized systematic classification and consistent method of describing nursing practice. Without a common language, data cannot be aggregated into a useful language.With regard to nursing informatics, what is meant by general systems theory? It organizes interdependent parts that, when working together, can produce a product that none used alone could produce.

rationale:
Nursing informatics uses a theoretical foundation. This theory organizes interdependent parts that, when working together, can produce a product that none of the interdependent parts used alone could produce.The nurse understands that the computer-based patient record (CPR) was developed to: Provide an instrument with which to obtain clinical information, transcribe data, and track the care of the client in a variety of settings

rationale:
The CPR basically refers to the same thing as the electronic medical record (EMR), the electronic patient record (EPR), and the electronic health record (EHR). It is important to note that the CPR is not the clinical information system (CIS), but instead is a complex computer system that captures, records, processes, and communicates client data. The CPR includes all information about an individual’s lifetime health status and health care and is maintained electronically. The nurse needs basic computer skills to work with the CPR.The nurse understands that computer monitoring on a telemetry unit: Provides streamlining of data that allows nurses to respond to client changes quickly

rationale:
The continuous flow of data from a computer allows nurses to respond to client changes very quickly. Timely nursing responses and actions are crucial in leading to positive outcomes when caring for critically ill clients. Computer monitoring is not a substitute for client observation. The number of nurses required to care for clients is not reduced because of computer monitoring, nor does it improve documentation, but rather provides a means to document data.When evaluating an Internet site, the nurse understands that: Credibility, accuracy, and reasonableness of the information should be considered

rationale:
The credibility of the information that you obtain from Internet searches should be challenged. It is important to be skeptical, because not all information that is posted is accurate. Information should be evaluated and reevaluated on a regular basis. It is important to remember that Internet information is dynamic and fluid in nature, as compared with printed information.The American Hospital Association and Congress have identified which of the following as major barriers to the full integration health information technology? Select all that apply. -Lack of standardization across point-of-care areas
-Funding issues
-No single set of privacy laws
-Lack of a unique client identifier number

rationale:
Research data support that the use of the computerized physician order system (CPOE), computerized decision support systems, medication administration record (MAR), and bar-codes on client identification bands can limit errors and improve care. Both organizations identify barriers as:
Lack of standardization across point-of-care areas—Laboratory data and pharmacy systems need to be integrated with the client’s health record.
Funding—Information technology is costly, and often the major costs are borne by hospitals rather than shared by other providers, payers, and employers.
Privacy laws—A single set of privacy laws is needed to simplify the task of communicating across agencies and local, state, and federal governments, which can make compliance difficult and interfere with client care.
Lack of a uniform approach (identifier number) to match the client to his or her record—A single authentication number is needed to reduce safety risks and provide a uniform access to a client’s data.Which of the following are considered nursing practice classification systems? Select all that apply. -North American Nursing Diagnosis Association International (NANDA-I) Approved List of Diagnostic Labels
-Nursing Interventions Classification (NIC) System
-Nursing Outcomes Classification (NOC) System
-Nursing Management Minimum Data Set (NMMDS)

rationale:
The ANA approved the establishment of the Nursing Information and Data Set Evaluation Center (NIDSEC) to review, evaluate against defined criteria, and recognize information systems from developers and manufacturers that support documentation of nursing care within automated nursing information systems (NIS) or within computer-based patient record systems (CPR). They recognized the following 13 nursing practice classification systems:
North American Nursing Diagnosis Association International (NANDA-I) Approved List of Diagnostic Labels
Nursing Interventions Classification System (NIC)
Nursing Outcomes Classification System (NOC)
Nursing Management Minimum Data Set (NMMDS)
Clinical Care Classification (CCC, formerly Home Health Care Classification [HHCC])
Omaha System
Patient Care Data Set (PCDS)
PeriOperative Nursing Dataset (PNDS)
SNOMED CT
Nursing Minimum Data Set (NMDS)
International Classification of Nursing Practice (ICNP)
ABC codes
Logical Observation Identifier Names & Codes (LOINC)

 

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