Health Care Delivery and CommunityBased Care

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Health Care Delivery and Community-Based Care
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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?

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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

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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

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Levels of Health Care

• Preventive
• Primary
• Secondary
• Tertiary
• Restorative
• Continuing

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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

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Issues in Health Care Delivery

• Competency
• Evidence-based practice
• Knowing clients
• Unlicensed assistive personnel
• Quality health care

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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

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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

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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

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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

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Levels of Health Services

• Population-based
• Clinical preventive
• Primary health care
• Secondary health care
• Tertiary health care

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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

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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

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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

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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

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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

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Competencies for Community-Based Nursing

• Case manager
• Collaborator
• Educator
• Counselor
• Client advocate
• Change agent

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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

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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