1 / 32

Enhancing Health Care Quality: Insights & Strategies for a Continuum of Care

Explore organizational frameworks, reimbursement methods, factors influencing care delivery, and the nursing role in quality management within the dynamic landscape of health care delivery. Learn about trends and responses to changes in the field.

tannerr
Download Presentation

Enhancing Health Care Quality: Insights & Strategies for a Continuum of Care

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Chapter 4 Health Care Delivery, Quality, and the Continuum of Care

  2. Health Care Delivery: Organizational Frameworks • Public sector • Official or governmental agencies • U.S. Department of Health and Human Services • Voluntary agencies • ANA, American Medical Association (AMA), American Cancer Society (ACS), and American Heart Association (AHA) • Nonprofit agencies (continued)

  3. Health Care Delivery: Organizational Frameworks • Private sector • All nongovernmental sources • Health insurance industry • Pharmaceutical companies • Suppliers of health care technology and equipment

  4. Health Care Team • Nurse (RN) • Physician (MD, DO) • Physician assistant (PA) • Pharmacist (RPh) • Dentist (DDS, DMD) • Dietitian (RD) (continued)

  5. Health Care Team • Social worker (SW) • Respiratory therapist (RT) • Physical therapist (PT) • Occupational therapist (OT) • Chaplain • Unlicensed assistive personnel (UAP)

  6. Nurse: Roles and Functions • Caregiver • Teacher • Advocate • Manager • Expert • Case manager • Team member

  7. Advanced Practice Nurse: Roles and Functions • Diagnose primary health problems • Prescribe therapies • Promote continuity of care • Specialize in variety of areas

  8. Reimbursement Methods • Private insurance • Managed care • HMO • Preferred provider organization (PPO) (continued)

  9. Reimbursement Methods • Government plans • Medicare • Medicaid • State Children’s Health Insurance Program (SCHIP)

  10. Factors Influencing the Delivery of Health Care • Cost • Access • Quality • Nursing supply and demand

  11. Cost • Contributing factors to high costs: • Aging population • Technological advances • Surplus of hospital beds • More people living with chronic illnesses • Barrier to access

  12. Access • Limiting factors: • No insurance • Cultural barriers • Few providers in rural and inner-city areas • Limited access to ancillary services

  13. Quality • Threats: • Inappropriate use of resources • Inappropriate substitution of personnel for registered nurses • Imbalance in supply and demand of registered nurses

  14. Nursing Supply and Demand • Nursing shortage could reach 500,000 by 2025 • Declining number of nursing faculty

  15. Responses to Health Care Changes • Nursing’s agenda for health care reform • Public versus private programs • Vulnerable populations • Community nursing organizations

  16. Continuum of Care • Levels of care • Health care settings • Fragmentation of care

  17. Levels of Care • Primary • Health promotion and illness prevention • Secondary • Diagnosis and treatment • Tertiary • Rehabilitation

  18. Health Care Settings • Hospitals • Extended care facilities • Home health agencies • Hospices • Outpatient settings (continued)

  19. Health Care Settings • Schools • Industrial clinics • Managed care organizations • Community nursing centers • Rural primary care hospitals

  20. Fragmentation of Care • Result of multiple providers and various care settings • Loss of individuality for client • Seamless service • Attempt to overcome delivery of fragmented services

  21. Quality Management in Health Care • Quality • Meeting or exceeding client requirements • Right thing • Right way • First time (continued)

  22. Quality Management in Health Care • Quality assurance • Continuous quality improvement • Total quality management

  23. Factors Influencing Quality • Consumer demands • Financial viability • Professional accountability • Regulatory requirements • Progress in quality improvement techniques • Changes in health care delivery (continued)

  24. Factors Influencing Quality • Legal implications of quality improvement • Nurses must understand roles that law, regulations, and ethics play in quality movement • Federal regulations • Agencies regulate health care standards • Imperative to adhere to standards

  25. Quality and Health Care Economics • Rising costs • Poor quality care • Doing more with less • Increasing efficiency and improving quality

  26. Principles of Quality Improvement • Quality as central theme • Organizational culture supports quality • Personal responsibility • Continual education • Monitored performance • Use of scientific approach • Accurate information

  27. Customer Satisfaction • Customers • Clients • Suppliers • Third-party payers • Families • Visitors • Employees • Community (continued)

  28. Customer Satisfaction • Satisfaction requires putting customer first

  29. Organizational Structure for Quality Management • Organizational culture • Leadership • Teamwork

  30. Process Improvement • Tools for measuring quality: • Audits • Peer reviews • Benchmarking • Clinical pathways

  31. Nursing’s Role in Quality Management • Roles: • Clinician • Team member • Manager • Must continue to strive for excellence

  32. Trends in Health Care Delivery • Aging U.S. population • Diversity • Single-parent families • Growth in outpatient settings • Technology • Disease prevention • More responsibility for care

More Related