introduction what institutions make up the healthcare system? what types of inpatient facilities...

Introduction

• What Institutions Make Up the Healthcare System?

• What Types of Inpatient Facilities Exist in the United States?

• What Types of Outpatient Facilities Exist in the United States?

Introduction

• What Do We Mean by Quality of Healthcare Services?

• How Care 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 Coordination of Health care?

Introduction

• How Can Electronic Medial Records Facilitate Coordination of Care and Improve 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 Quality of Care?

ScenariosHealth Care Institutions

George didn’t have health insurance and went to the emergency room whenever he needed care. They emergency department treated him but then tried to get him connected to a primary care facility. He couldn’t go to the Veteran’s Administration facilities because he wasn’t a veteran. They sent him to the local community health center which they called the “safety-net” provider. George did go to the community health center where they tried to treat his problems and get him his medicines despite not having insurance. When he got sick, however, George went back to the emergency department. Even George agreed that it wasn’t the best way to get care but wondered what was needed to make the system work better?


Laura had breast cancer and it had spread. Her medical records were everywhere in the hospital, four doctor’s offices, two emergency rooms, and an outpatient imaging facility. No one seemed to know how to put the system together. Whenever her old records were essential they asked her to go get a copy of the records and bring them to her next appointment. That worked for a while but when she ended up in the emergency room her records just weren’t available. There must be a better way, Laura through to herself. Hasn’t the health care system discovered the Internet yet?


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 couldn’t 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 to the nursing home. Looking back the family asked, how can we do better to address the needs of Alzheimer’s patients?

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 specialistsSatisfaction of patients in terms of problems obtaining care

Patient satisfaction surveys, patient grievances and follow-up, interviews with staff



Qualified providers

Personnel licensed and trained and patients satisfied with services

System for checking credentials, sanctionsPatient satisfaction with providers of care

Presence of system for checking credentialsPatient satisfaction surveys


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 servicesEvidence that patients are receiving appropriate screening tests

Review of independently-verified clinical recordsReview of responses from patients



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-to-date careProviding specific services, such as smoking cessation

Review of independently-verified clinical recordsInterviews with staff



Living with illness Quality of services that help people manage chronic illness

Programs to assist patients to manage chronic conditions like asthmaProvision of specific services, such as eye examinations for diabetics

Review of independently-verified clinical recordsInterviews with staff

Type of coordination of care, intended functions and challenges with implementation

Type ofcoordination

Intendedfunction

Challenges withimplementation

Clinician-patient relationship

Continuity as amechanism for ensuringCoordination

Development ofindividual relationshipsbuilt on knowledge andtrust over extendedperiods of time

Multiple cliniciansinvolved in care

Team rather thanindividual concept ofprimary care

Frequent changes ininsurance coveragerequire change in healthprofessionals


Type ofcoordination

Intendedfunction


Institutionalcoordination

Coordination ofindividual’s informationbetween institutionsneeded to informindividual clinical andadministrative decisionmaking

Different structures andgovernance often lead tolack of coordinationbetween inpatient facilitiesand between inpatient andoutpatient facilities


Type of coordination

Intendedfunction


Financialcoordination

Implies that a patient hascomprehensive coveragefor services provided bythe full range ofInstitutions

Maximize the efficiencyof the care received andto minimize theadministrative effortrequired to manage thepayment system

Lack of comprehensiveinsurance coverage oftenmeans that essentialservices cannot bedelivered or cannot bedelivered at the mostefficient or effectiveinstitutional site


Type of coordination

Intendedfunction


Coordinationbetween

Health care andPublic health

Coordination of servicesbetween clinical careand public heath

requirescommunication toensure follow-up and toprotect the health ofothers

Lack of coordination ofservices between publichealth services andclinical care is oftenbased on lack ofcommunication

introduction what institutions make up the healthcare system? what types of inpatient facilities...

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