Explain the continuum of care process in a variety of settings – Raymond is a 54-year-old man who lives in a rural part of Mississippi. He is a skilled worker but his job does not provide health insurance. Raymond does not qualify for Medicaid, and he cannot pay for health insurance. He has not received consistent or coordinated healthcare for most of his life.
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- Raymond is a 54-year-old man who lives in a rural part of Mississippi. He is a skilled worker but his job does not provide health insurance. Raymond does not qualify for Medicaid, and he cannot pay for health insurance. He has not received consistent or coordinated healthcare for most of his life. The closest clinic is over 30 miles away, and he does not have the money for both the co-pays and gas. Raymond has been diagnosed with hypertension, and his family history includes pulmonary embolisms and heart disease.
Emmanuel is 55-year-old man who lives in Jackson, Mississippi. He is an office manager and receives insurance from his employer. Emmanuel has had annual medical and dental exams from the same providers for several years. Emmanuel has a family history of Type 2 diabetes and he was recently diagnosed as pre-diabetic and obese. Emmanuel received referrals to an endocrinologist and a registered dietitian, and he was instructed to increase his physical activity.
- Describe the challenges and barriers to access; affordability; and availability for Raymond and Emmanuel. Indicate why these challenges exist (1–2 pages)
- Describe the potential social, economic, and health outcomes for Raymond and Emmanuel if prevention had a higher priority in the US. Include how the barriers identified in Objective 1.1 can be overcome and how this could improve their outcomes (1 page)
Your Response
Geographical Accessibility
Health care systems are dispersed in different locations across the states, making them accessible to nearby populations. People living far from health care facilities find it challenging to travel, especially where they can hardly meet their day-to-day needs. Raymond lives averagely 30km away from the nearest health facility, presenting hurdles he encounters to seek medication for his pre-existing condition. He represents individuals from low-income households lacking funds and available networks to access service.
Emmanuel has a well-paying job that can cater to his medical bills, even when without insurance. Also, a health care facility is near, meaning he can visit regularly. There exist disparities in both scenarios, with Raymond not able to access medical facilities because of his location and economic status.
Affordability
Raymond lives in a rural setting with little income that can sustain himself but does not qualify for Medicaid, and neither does his employer provide insurance. He does not have the funds to pay for his insurance and cater for travel expenses to seek medication. Health care facilities, especially the profit-making organizations, cannot make admissions for people like Raymond, who cannot pay for medicines and services. He has to seek alternative medical facilities once he finds funds to facilitate transport and medicine.
Emmanuel is financially stable is he pays and leans on his health insurance for medication. Even though his check-ups are annual, he manages to pay up without having to strain the availability of money. Disparities between Raymond and Emmanuel in the financial context shows how some people miss out on quality care.
Availability
The availability of medical services depends on one’s orientation in society, either geographically or financially. Raymond, in the rural parts of Mississippi, is not able to get medication because there lacks hospital facilities in that area.
Emmanuel can access medication easily since he resides in an urban area hence available medicines in a health care setting. These disparities exist because of location and lack of developments in the rural region.
Potential Social, Economic, and Health Outcomes
For Raymond, paying exclusively for either medication or health insurance will render him miserable without any other means of living. His health will likely deteriorate, and in the most severe case, could suffer from a stroke or heart attack. Moreover, Raymond will not conduct daily activities generally because of the underlying condition.
Emmanuel, on the other hand, will continue to enjoy medication catered for by his insurance, with the most severe conditions leading to change in lifestyle. Lifestyle changes will entail food and daily activities. Diabetes could cause detrimental effects and even sudden death.
Interventions
Community participation
The communities play a crucial role in health care systems as they create awareness and education activities to members in the society. Social marketing strategy helps educate and sensitize the public when to seek medication.
Community-based interventions such as accreditations address the availability of healthcare systems.
Provision of essential services such as vaccinations and maternity services to vulnerable populations: regulation of these services should be regulated to discourage unethical practices from creeping in the system (Goudge et al., 2009). Some of the essential services include culturally sensitive care, outreach services, home maternity services, emergency transport, and peripheral health units.
Furthermore, improved management systems in the form of enhanced supervision and feedback mechanisms address accessibility to health care services.
Rubric
0 Not Present | 1 Needs Improvement | 2 Meets Expectations | 3 Exceeds Expectations | |
Sub-Competency 1: Describe how the delivery of care is affected for those with and without insurance in relation to cost, quality, and access. | ||||
Learning Objective LO 1.1: Describe challenges and barriers to access, affordability, and availability for individuals with and without insurance. | Comparisons between patients’ history of care and possible health outcomes are missing. | Response inaccurately describes the different challenges and barriers to access, affordability, and availability for the individuals in the case presented. Or, issues of access, affordability, cost, and/or they exist are not discussed. Challenges and barriers do not illuminate differences between insured and uninsured individuals. | Response accurately describes the different challenges and barriers to access, affordability, and availability for the individuals in the case presented and why they exist. Challenges and barriers illuminate differences between insured and uninsured individuals. | Response demonstrates the same level of achievement as “2,” plus the one of the following: Response includes examples about how health insurance affects patient and population health outcomes and impacts life expectancy. or Response describes challenges and barriers for a third individual (hypothetically) to highlight additional nuances related to access, affordability, and availability of individuals with and without insurance. |
Learning Objective LO 1.2: Describe potential social, economic, and health outcomes if prevention has a higher priority in the U.S. | Description of potential social, economic, and health outcomes if prevention has a higher priority in the U.S. is missing. | Response vaguely or inaccurately describes potential social, economic, and health outcomes for the individuals in the case presented, given an increase in preventative care in the US, or Response does not address the situations of both individuals in the case. | Response accurately describes potential social, economic, and health outcomes for the individuals in the case presented, given an increase in preventative care in the US. | Response demonstrates the same level of achievement as “2,” plus the following: Response provides examples of two preventative care programs and how they affect social, population, economic, and health outcomes. |
- Define the continuum of care process, including objectives and the relationship to organizations and patients.
The health care system defines a continuum of care as a range of services developed and organized to address a variety of needs individuals have as they grow. This concept recognizes and considers the availability and extent of short-term and long-term care systems and services in the community and institutional settings. Included in the continuum of care are residential alternatives, in-home care, community programs, and institutional facilities.
The continuum of care also refers to the use of health care services from birth through death (Graham, & Varghese, 2012). The continuum of care is comprehensive as it includes patients who use the services over time. The biggest challenge that faces the health care delivery system is the availability of funds; Because of the high number of adults now reaching 65 and retirement age, as well as reaching the time in life when medical problems increase.
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Many seniors are living alone & may need help at home as they age. Some have medical issues, and they will need or do need help with physical care & meals. Many seniors want to remain in their homes. Since many people would rather stay in their own homes, many unfortunately cannot afford to pay the medical staff. Many people need around the clock medical attention, and this is very costly. Since many people are on fixed incomes at this time in their life, getting the proper medical care can be very difficult.
Rubric
Sub-Competency 2: Explain the continuum of care process in a variety of settings. | ||||
Learning Objective LO 2.1: Define the continuum of care process. | Definition of the continuum of care processis missing. | Response vaguely defines the continuum of care process. | Response clearly defines the continuum of care process, including objectives and the relationship to organizations and patients. | Response demonstrates the same level of achievement as “2,” plus the following: Response provides examples that illustrate the benefits of the services along the continuum of care. |
- Describe the following settings and types of care, including objectives and basic components.
- Primary care
- Secondary (general hospital)
- Tertiary (teaching)
- Specialty hospitals
- Outpatient programs (surgery, outpatient rehab)
- Nursing homes
- Rehabilitation settings
- Assisted living
- Home health
- Hospice
Your Response
Primary Care
This is a health care approach addressing the health challenges, needs, and preferences of a patient and their family caregivers (Bodenheimer, & Pham, 2010). Diversification of primary care constitutes comprehensive treatment, rehabilitation, and palliative care. Primary care plays a central role in a healthcare delivery system. The political, economic and social forces can influence how organizations operate as well as the practice of management. Primary care clinics should build strong healthcare system that ensures positive health outcomes and health equity. Primary health care becomes a practical approach to provide essential health care at affordable cost to all the members of the community with their full participation. The basic tenets of primary health care rest on equitable distribution of resources, inter-sectoral coordination, appropriate technology and community participation. Though all factors are responsible for successful implementation of primary health care activities, community participation is perhaps the crucial determinant of success of any developmental program.
Secondary Care
This is care given in a large and specialized facility upon referral by a primary care provider. The skilled care manifests in advanced and professional skill, knowledge, and equipment. In secondary care provision, there is centralized focus on specific part of the body or a specific medical condition. Patients who receive this care are often referred from primary care health care systems for specialized treatment. Objectively, care varies from one facility and could render a patient distressed from seeing several specialists who can diagnose different conditions.
Tertiary Care
This is a type of specialized care provided in high-end and state-of-the-art facilities because they can give attention over a long duration. The procedures are seen in complex surgeries and therapies. Tertiary care, which lies at the apex of the organizational pyramid, involves the management of rare and complex disorders such as pituitary tumors and congenital malformations. Tertiary care are specialists located at a few tertiary care medical centers. The dispersed model has no limit on referrals, the physicians goes to any level they want to at any time. The amount of remuneration is based on the average expected health care utilization of that patient, with greater payment for patients with significant medical history.
Specialty Hospital
They are hospitals set aside for patients requiring specialized treatment in complex surgical procedures, orthopedic, and cardiac conditions. They are well-equipped to meet the needs of patients. Despite diverse models present in healthcare settings, specialty clinics form a critical base for continuum care. Specialist physicians and doctors focus on individual patients all through the recovery process. Dedication and work ethic among nursing staff provides suitable environments for effective service delivery.
Outpatient Programs
These are treatment programs provided for patients on an outpatient basis, in that patient receive treatment from their homes and communities (McCarty et al., 2014). This method is cost-effective, especially for those who cannot afford high rates of inpatient treatment systems. Outpatient programs are designed in a way they are accessible and effective in addressing underlying health conditions. The systems are in tandem with hospital-based procedures and allocations especially where financial flexibility is possible. Patients who cannot afford outpatient services receive alternative packages serving similar functions and roles towards achieving desirable health outcomes.
Nursing Homes
These are facilities registered by the government as they provide care for patients with chronic illnesses through skilled and primary nursing care. They are a place of residence for people who require constant nursing care and have significant deficiencies with activities of daily living. Nursing aides and skilled nurses are usually available 24 hours a day. Residents include the elderly and younger adults with physical or mental disabilities. Residents in a skilled nursing facility may also receive physical, occupational, and other rehabilitative therapies following an accident or illness. Some nursing homes assist people with special needs, such as Alzheimer patients
Rehabilitation Settings
These are acute health care settings that help an individual regain impaired thinking, and learning abilities used injury, disease, or treatment. Rehabilitation programs generally utilize a comprehensive and integrated team, consisting of medicine, nursing, physiotherapy, occupational therapy, speech-language pathology, clinical nutrition, pharmacy, social work, and therapeutic recreation professionals. Studies show that the complex process of rehabilitative care requires patient and family involvement, relevant knowledge and skills, and coordination of teams of specialized inter-professional providers. Although the evidence for costly comprehensive rehabilitation teams. Nurses understand the underlying key principles of rehabilitation activities as a continuous process throughout the day, active patient participation, goal-orientation, and multi-professional teamwork. The roles are expansive, including advocacy for persons to attain optimized function and independence, teaching ADL, environmental and adaptive equipment assessments, referrals to other specialties, and patient/family education.
Assisted Living
These are facilities developed to allow people persons needing personalized care to have ready access to needed care. The systems are common among the elderly who need help daily for exceptional living. These facilities provide supervision or assistance with activities of daily living (ADLs); ALFs are an eldercare alternative on the continuum of care for people, for whom independent living is not appropriate but who do not need the 24-hour medical care provided by a nursing home and are too young to live in a retirement home. Assisted living is a philosophy of care and services promoting independence and dignity.
Home Health
This type of care is provided at the comfort one’s home and mainly administered to the elderly, illness, or injury. Receiving health care from home is cheap and convenient since you are attended to from home. Home health care allows you to stay at home, provides a nurse to assist you with your needs and possibly a nurse’s aide to assist with anything else. All these options to serve the person as a whole and keep them where they are comfortable. The nursing process in home health is the same as it would be anywhere else. The nursing process is a systematic method in which the nurse and client work together to plan and carry out effective nursing care through assessment, nursing diagnosis, and planning.
Hospice
This is health care provided for patients with severe health conditions by meeting emotional and spiritual needs (Jennings et al., 2010). Hospice care seeks to eliminate suffering and boost quality of life. Patients under hospice care often have limited life choices as in terminally ill persons. Nevertheless, they are entitled to quality services that informs available options to choose from in meeting individual values, culture, and beliefs. These care components ensure that patient’s wishes are respected so that they get relief from physical, spiritual, and emotional pain. The hospice care also attends to the needs of family care givers with respect to the patient.
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Rubric
Sub-Competency 2: Explain the continuum of care process in a variety of settings. | ||||
Learning Objective LO 2.2: Describe various healthcare settings and types of care. | Descriptions of various healthcare settings and types of care is missing. | Response inaccurately describes the following settings and types of care and/or does not include objectives and basic components. Primary careSecondary (general hospital)Tertiary (teaching) Specialty hospitalsOutpatient programs (surgery, outpatient rehab)Nursing homesRehabilitation settingsAssisted livingHome healthHospice | Response describes the following settings and types of care, including objectives and basic components. Primary careSecondary (general hospital)Tertiary (teaching) Specialty hospitalsOutpatient programs (surgery, outpatient rehab)Nursing homesRehabilitation settingsAssisted livingHome healthHospice | Response demonstrates the same level of achievement as “2,” plus the following: Response describes how the services may be coordinated for a particular patient. |
- Describe the personnel who should be part of a interdisciplinary team that focuses on patient-centered care in an inpatient setting. List at least six disciplines and provide a rationale for including each as a member of the team. (1 page)
Your Response
Nursing Aide/ Assistant
Nursing assistants play a crucial role in providing patient-centered can for patients with varied health conditions despite existing age differences. Their places of work are, but not limited to, nursing homes, home care, hospitals, and community-based long-term care. They are considered the closest to patients and, for that reason, conduct their activities under a licensed nurse’s supervision, thus the need to be involved in inpatient care.
Surgical Technicians
They are members of operating room teams. They, in most cases, take up the role of circulating assistant nurse hence their importance in the group. Besides, technicians, before any surgical procedure commences, help preparation of operating rooms where they put together needed instruments, assess their functionality, and initiate changes required. The technicians fulfill their duties under the supervision of assigned surgeons.
Anesthesiologists
They also form part of the multidisciplinary team in a surgery process. This specialty is critical as it required knowledge and skill to facilitated outstanding perioperative care of patients, during and after surgery (Pagel, & Hudetz, 2011). The activities surrounding patient care in these crucial stages involve the use of anesthesia, pain-relieving medicines, intensive care medicines, and critical emergency medicines.
Surgeons
Surgeons are the lead experts in operations rooms as they are tasked with conducting minor to significant operations assisted by surgical technicians. They oversee all procedures to ensure care standards and safety get followed for better patient outcomes. Productive and successful surgeries are determined by the level of expertise on the whole surgical team and their input.
Attending Physicians
They are medical practitioners mandated to provide quality care to specific patients during and after their hospital stay elapses. In some cases, attending physicians are categorized as private physicians because of their dedication to a single patient. Despite their stay not being fully within a hospital facility, they attend to their patients to give treatment and do follow-ups.
Nurses
Professional nurses provided quality care for patients, and also work closely with therapists and family members of a patient. Their practices are slightly different from other specialties owing to their general perspective of patient care, training, and scope. The American Nurses Association protects the nurses and their rights towards a conducive working environment.
Rubric
Sub-Competency 3: Explain processes, roles, and responsibilities in the delivery of healthcare. | ||||
Learning Objective LO 3.1: Describe the disciplines that should be part of a multidisciplinary team for a particular healthcare context. | Description of the disciplines that should be included in an interdisciplinary team is missing. | Response vaguely describes, or describes fewer than six disciplines that should be part of a multidisciplinary team focused on patient-centered care in an inpatient setting. Response provides limited or illogical justification for inclusion of the disciplines chosen. | Response thoroughly describes at least six disciplines that should be part of a interdisciplinary team focused on patient-centered care in an inpatient setting. Response provides a logical justification for the choice of disciplines included in the team. | Response demonstrates the same level of achievement as “2,” plus the following: Response describes how team composition and expertise benefit patient outcomes. |
- You are assisting the human resource director at a large general hospital. As part of a report to the chief executive officer (CEO), she has asked you to outline specific essential functions/responsibilities and goals for at least three clinical, three technical, and three administrative departments (9 departments total). Describe the essential functions/responsibilities and goals of these hospital departments. (1–2 pages)
Your Response
Administrative Department
Public Relations Department
Health care organizations require elaborate and specialized public relations systems in managing health matters and ever-rising lawsuits. The department key role is to uphold the integrity of the organizations upon criticism and challenges.
Public Health Department
This department focusses on essential health issues related to vaccinations, research, food inspection, and infectious diseases (Joyce et al., 2015). It ensures the well-being of the general public besides improving health standards.
Mental Health Department
Inpatient and outpatient services are included and addressed in this department, notwithstanding patient location. Management systems that head the department focus primarily on individuals affected by mental health and substance abuse.
Clinical Department
Cardiology Department
Cardiology deals with diagnosis, treatment, and disorders of the heart. The department concentrates on heart diseases, most notably coronary artery disease.
Oncology Department
This department focusses on prevention, diagnosis, and treatment of cancer. Testing and screening activities facilitate steps towards eradicating cancer.
Neurology Department
Neurologists are specialists concerned with the study, treatment, and disorders of the nervous system, brain, and spinal. The human body systems are sophisticated, requiring specialized and professional neurologists.
Technical Department
IT Department
Hospital IT departments in the modern-day patient care help achieve medical goals by medical staff and clinicians. The smooth running of the IT department ensures efficient management of medical software and related processes.
Security Department
Security systems in any organization provide safe working environments of clinical staff and patients from being attacked by outsiders together with preventing fraudulent activity in the facility.
Environment Department
Health care facilities should be kept in clean and conducive conditions to prevent further infections while creating a habitable environment. Internal and external environments are critical to the recovery of patients.
Rubric
Sub-Competency 3: Explain processes, roles, and responsibilities in the delivery of healthcare. | ||||
Learning Objective LO 3.2: Define the functions/responsibilities and goals of clinical, technical, and administrative professions in the delivery of healthcare. | Description of the functions/responsibilities and goals of hospital departments is missing. | Response vaguely describes the functions/responsibilities and goals of hospital departments. | Response thoroughly describes at least three functions/responsibilities and one goal of clinical, technical, and administrative departments. | Response demonstrates the same level of achievement as “2,” plus the following: Response describes how the departments work together to achieve organizational and outcome goals. |
- Admission policies can differ between various types of healthcare organizations. Provide compare and contrast how admission policies could differ between for-profit and nonprofit organizations, and how this difference relates to access to care.
Your Response
Admission policies are different in healthcare settings, depending on whether an organization is a profit or non-profit. Profit organizations adopt admission policies that favor patients with the ability to pay for healthcare service. In contrast, non-profit institutions provide healthcare services irrespective of an individual’s or community’s financial strength (Brown et al., 2012). The non-profit groups have little or concern for commercial gains but mostly aligned to offer quality services.
Health care organizations operating on profit mechanisms seek to satisfy investors and shareholders who ensure the regular running of the institution. It is for this reason that paying before admission is crucial; hence lack of finances rules out the possibility of admission. These systems are conventional in private entities that have made considerable investments in hospital equipment, and workforce thus work to realize returns. Moreover, they do not offer free services, not unless one can pay mandatory charges. The profit-seeking organizations have reduced patient population accessing medical services with targets being individuals who can pay for services.
Rubric
Sub-Competency 3: Explain processes, roles, and responsibilities in the delivery of healthcare. | ||||
Learning Objective LO 3.3: Explain how admission policies differ in various types of healthcare organizations and how this relates to access to care. | Explanation about how admission policies differ in various types of healthcare organizations and how this relates to access to care is missing. | Response vaguely explains how admission policies differ in various types of healthcare organizations and how this relates to access to care; and/or the differences between for-profit and not-for-profit healthcare organizations are unclear or missing; and/or only one difference is addressed. | Response clearly explains two differences in admissions policies for the various types of healthcare organizations and how this relates to access to care. Response includes differences between for-profit and not-for-profit healthcare organizations. | Response demonstrates the same level of achievement as “2,” plus the following: Response provides clearly written descriptions of two types of nonprofit and two types of for-profit hospitals and the types of patients they serve. |
There are many different organizations and institutions that are major players in the healthcare system. Briefly describe how each of the following influences healthcare. Consider both potential and negative influences when formulating your answer. Use at least one other reference in addition to the organizations website for each organization.
- Pharmaceutical Research and Manufacturers of America (PhRMA)
- Food and Drug Administration (FDA)
- American Medical Association (AMA)
- American Hospital Association (AHA)
- Joint Commission (JC)
- Centers for Medicare and Medicaid Services (CMS)
- State Department of Health (student’s state)
- Centers for Disease Control and Prevention (CDC)
- U.S. Department of Health and Human Services
Your Response
Pharmaceutical Research and Manufacturers of America (PhRMA)
Representing many companies involved in the pharmaceutical industry, PhRMA, advocates primarily for public policies and regulations that protect and enhance discoveries of new medicines (Khanna, 2012). The organization developed programs that provided patients with crucial information; new and free prescription drugs available in the market. Pharmaceutical Research and Manufacturers of America promote government supported new and innovative medical technology and services research that is focused on meeting patient needs this research is known as health outcomes research. PhRMA has provided principles on what health outcomes research is and how it should be implemented within healthcare. Organizational principles establish a framework to help ensure government-supported health outcomes research. Research that meets these principles can improve health care decision-making, while research inconsistent with these principles make it more difficult for patients to obtain the best and most efficient medical care.
Food and Drug Administration (FDA)
The organization was developed to ensure prescription drugs are used effectively besides upholding its safety standards. Despite huddles with drug approval processes, new information on drugs emanates after approval requiring the FDA to act accordingly in curbing unprecedented effects. The Food and Drug Administration’s draft guidance updates the policy regarding the use of animal-derived material in medical device manufacturing. The role of animal derived-material in medical devices is well established. However, these materials may carry a risk of transmitting infectious disease when improperly collected, stored or manufactured. The guidance describes the information you should document at the manufacturing facility and include in any premarket submissions.
American Medical Association (AMA)
The association focusses on healthcare reforms hence its major input in advocacy activities. It has encouraged and championed for health insurance for all Americans, patients to have freedom of choice, freedom of practice, and universal access for patients. In the past, AMA petitioned agencies such as U.S. Department of Health and Human Services and the Office of Health Information Technology. It opposed the transition to ICD-10 and requested changes to the meaningful use and Electronic Health Record certification programs The main concerns of AMA are implementation of the Affordable Care Act, health information technology, issues related to Medicare, patient safety, and quality improvement. It works with other organizations to petition changes or updates to existing policies that effect medical workers and patients. Additionally, AMA publishes medical journals, such as the Journal of American Medical Association which includes articles on medicine, healthcare and healthcare affecting policies. AMA has influenced how health information technology is today.
American Hospital Association (AHA)
The association seeks to enhance advancements and innovations in the healthcare sector by noting changes around them. Techniques used for the cause involve establishing market insights, improved partnerships, and upscaling health care practices across patient populations (Charles, Gabriel, & Furukawa, 2013). Most notable challenges being with health care systems unable to keep up with fast-rising innovations and technological advancements. The American Hospital Association plays an important role in innovating and reshaping how health systems deliver care. However, the health care forces are working through the AHA to meet the new challenges including aging population, physical healthcare among others, moreover, it is working to support hospitals that are experiencing some unique workforce issues by offering the current models and research that is necessary for the care delivery, supply and demand of health experts and the corresponding clinical department.
Joint Commission (JC)
The joint Commission sets standards that help health care institutions objectively evaluate their processes to improve patient outcomes and institutional goals. The performance of the organization is mainly dependent on patients, health care providers, and hospice functions. The Joint Commission (JC) is an organization that accredits and certifies over 20 thousand programs and health care facilities in the United States. It is a nonprofit and independent organization well-known as the symbol of a quality organization. Health care facilities that are certified by it have shown a commitment to attain high quality standards and performance. This program went into effect January 1, 2003. Accreditation services are provided for Hospitals, home care, nursing homes, behavioral health centers, rehabilitation facilities, ambulatory clinics, and laboratories. JC also provides certification services for Disease specific care, palliative care, health care staffing services, and critical access. The Joint Commission has created standards that are the basis of their evaluation process. This will help health care organizations measure, assess and improve their performance. These standards put the focus on important functions within the organization that are indispensable to being able to provide extremely safe and very high quality care.
Centers for Medicare and Medicaid Services (CMS)
CMS provides health coverage to more than 100 million people through Medicare, Medicaid, the Children’s Health Insurance Program, and the Health Insurance Marketplace. CMS also has other responsibilities including the administrative simplification standards from the Health Insurance Portability and accountability Act of 1996 (HIPPA) quality of standards under the Clinical Laboratory Improvement. It facilitates health care processes by collecting and studying data variables and consequently producing research reports to back their activities.
State Department of Health (student’s state)
The state has enormous responsibility to its citizens, most importantly, health care provision for all. Under health departments, several activities and programs are undertaken: epidemiology, vaccinations, environmental health, and preventive medicines. The programs provide and improve health care conditions and patient outcomes. The rising costs of health care has become a top priority in the United States; shifting the main focus on what drives the high costs and what policies might help in reducing these costs. It is important for the United States to shift focus towards this priority due to the rate of increase in health care spending currently exceeds economic growth. With pressure to reduce costs due to economic constraints and aging population it is imperative for lawmakers to determine ways to reduce these costs while not losing the focus of improving health outcomes.
Centers for Disease Control and Prevention (CDC)
The agency focusses on enhancing and protecting public health by containing diseases and their infectious nature. Besides conducting education and awareness activities, CDC also conducts research and studies on highly contagious diseases. It is the leading federal agency in protecting people’s health in the US. Their primary focus is to control and decrease the spreading of infectious diseases, and to help identify behavioral health hazards, moreover improving the overall public health. The CDC is also in charge of publishing the weekly Morbidity and Mortality report.
U.S. Department of Health and Human Services
It is a federal agency mandated to protect all Americans by improving overall health, safety, and well-being. Health care organizations are directly affected by decisions made by the agency, mainstreaming activities, and policies across health care factions. The U.S. Department of Health & Human Services oversees all the programs that have the citizens well-being as the utmost priority. They offer services not only to children and adults with mental and/or physical disabilities but also to senior citizens and regular children and their families. The U.S. Department of Health & Human Services protects the health of all Americans and provides essential human services especially to those who are least able to help themselves. They provide access to high-quality health care, help people find jobs and parents find affordable child care, it keeps food on Americans’ shelves safe and infectious diseases at bay.
Rubric
Sub-Competency 4: Describe the organizations and institutions that are major players in the healthcare system. | ||||
Learning Objective LO 4.1: Describe how major healthcare organizations and institutions influence healthcare. | Description of how major healthcare organizations and institutions influence healthcare is missing. | Response vaguely or incompletely describes how each of the following influences healthcare: Pharmaceutical Research and Manufacturers of America (PhRMA)Food and Drug Administration (FDA)American Medical Association (AMA)American Hospital Association (AHA)Joint Commission (JC)Centers for Medicare and Medicaid Services (CMS) State Department of Health (student’s state)Centers for Disease Control and Prevention (CDC) U.S. Department of Health and Human Services | Response clearly and accurately describes how each of the following influences healthcare: Pharmaceutical Research and Manufacturers of America (PhRMA)Food and Drug Administration (FDA)American Medical Association (AMA)American Hospital Association (AHA)Joint Commission (JC)Centers for Medicare and Medicaid Services (CMS) State Department of Health (student’s state)Centers for Disease Control and Prevention (CDC) U.S. Department of Health and Human Services | Response demonstrates the same level of achievement as “2,” plus the following: Response provides examples about how patients are directly impacted by two or more of these major players. |
- Define vertically integrated health systems and horizontally integrated systems, including the business goals and patient outcomes. Then, explain the impact these systems have on healthcare today. (1 page)
Your Response
Vertically integrated health care systems describe procedures targeted at treating given medical conditions of a patient that stream across organizational boundaries, linking community-based service generalists and specialists in the established hospital setting. The processes involved in the integration tool allow for coordination of services and grouping organizations providing different levels of care under a similar management system (Valentijn, Schepman, Opheij, & Bruijnzeels, 2013). The system presents numerous benefits ranging from improved efficiency, continuum care, quality care, besides reducing contracting rates by patients and persons seeking hospice care. Moreover, the vertically integrated systems utilize models in the form of alliances with physicians and available health plans in achieving patient-centered care.
As you continue, thestudycorp.com has the top and most qualified writers to help with any of your assignments. All you need to do is place an order with us. (Explain the continuum of care process in a variety of settings)
Horizontal integration, on the other end, incorporates coordinated activities at similar stages in operational units regarding service delivery. In essence, this system uses principles where organizations providing the same and identical level of care, are grouped under one management system. Some of the conventional models making use of vertical integration are multihospital systems, and local network systems developed from mergers between hospitals and health care institutions.
The integration systems work to achieve set business goals and improve patient outcomes through sophisticated and well-organized institutional structures. It provides alternate and preferred medical aid towards improving patient experience, especially among long-term care patients (Valentijn, Schepman, Opheij, & Bruijnzeels, 2013). The benefits of integrated systems are many but not limited to enhance communications, pharmaceutical management, enhanced community health, mainstreamed continuum care, and bolstered care management.
Rubric
Learning Objective LO 4.2: Define vertically and horizontally integrated health systems. | Definition of vertically and horizontally integrated health systems is missing. | Response vaguely defines vertically and horizontally integrated health systems and/or does not include the business goals and/or patient outcomes. Response vaguely explains how these systems impact healthcare today. | Response clearly defines vertically and horizontally integrated health systems, including the business goals and patient outcomes. Response explains how these systems impact healthcare today. | Response demonstrates the same level of achievement as “2,” plus the following: Response provides an example of vertically and horizontally integrated health systems. |
References
Bodenheimer, T., & Pham, H. H. (2010). Primary care: current problems and proposed solutions. Health affairs, 29(5), 799-805.
Brown, R. S., Peikes, D., Peterson, G., Schore, J., & Razafindrakoto, C. M. (2012). Six features of Medicare coordinated care demonstration programs that cut hospital admissions of high-risk patients. Health affairs, 31(6), 1156-1166.
Charles, D., Gabriel, M., & Furukawa, M. F. (2013). Adoption of electronic health record systems among US non-federal acute care hospitals: 2008-2012. ONC data brief, 9, 1-9.
Goudge, J., Gilson, L., Russell, S., Gumede, T., & Mills, A. (2009). Affordability, availability and acceptability barriers to health care for the chronically ill: longitudinal case studies from South Africa. BMC health services research, 9(1), 75.
Graham, W. J., & Varghese, B. (2012). Quality, quality, quality: gaps in the continuum of care. The Lancet, 379(9811), e5-e6.
Jennings, B., Ryndes, T., D’Onofrio, C. A. R. O. L., & Baily, M. A. (2010). Access to hospice care: Expanding boundaries, overcoming barriers. Palliative care: Transforming the care of serious illness, 159-164.
Joyce, B. L., Harmon, M. J., Pilling, L. B., Johnson, R. H., Hicks, V. L., & Brown-Schott, N. (2015). The Preparation of Community/Public Health Nurses: Amplifying the Impact.
Khanna, I. (2012). Drug discovery in pharmaceutical industry: productivity challenges and trends. Drug discovery today, 17(19-20), 1088-1102.
McCarty, D., Braude, L., Lyman, D. R., Dougherty, R. H., Daniels, A. S., Ghose, S. S., & Delphin-Rittmon, M. E. (2014). Substance abuse intensive outpatient programs: assessing the evidence. Psychiatric Services, 65(6), 718-726.
Pagel, P. S., & Hudetz, J. A. (2011). An analysis of scholarly productivity in United States academic anaesthesiologists by citation bibliometrics. Anaesthesia, 66(10), 873-878.
Valentijn, P. P., Schepman, S. M., Opheij, W., & Bruijnzeels, M. A. (2013). Understanding integrated care: a comprehensive conceptual framework based on the integrative functions of primary care. International journal of integrated care, 13.
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