World History 102, week 4 notes
World History 102, week 4 notes Hist 102-004
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This 7 page Class Notes was uploaded by Loretta Hellmann on Friday February 19, 2016. The Class Notes belongs to Hist 102-004 at Western Kentucky University taught by Marko Dumancic in Spring 2016. Since its upload, it has received 28 views. For similar materials see WORLD HISTORY II in History at Western Kentucky University.
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Date Created: 02/19/16
Week 4 Notes Thursday, February 18, 2016 9:37 AM Thursday Types and roles of patients Persistent historical perceptions of patients as needy and compliant with authoritarian professionals conditioned patients to assume submissive "sick role" More educated and assertive patients increasingly reject passive roles and demand participation in care Patient rights, responsibilities Rights protected by US constitution, state laws, regulations "Bill of Rights" American Hospital Association, provides to every patient upon admission Patient responsibilities: accurate information, respect providers, other patients, financial obligations Complexity challenges rights Patient Bill of Rights 1 Receive respectful, considerate treatment 2 Know names and titles of all individuals providing their care 3 Complete and understandable explanations of their diagnosis, treatment and prognosis 4 Receive from physician all information necessary to provide informed consent 5 Request and receive consultation of diagnosis and treatment or obtain a second opinion 6 Set limits on the scope of treatment or refuse and be informed of consequences of such refusal 7 Leave the hospital, unless unlawful, even against physician's advice and receive an explanation of responsibilities in exercising that right 8 Request and receive info and assistance in discharging financial obligations and review a complete bill, regardless of payment source 9 Access their records on demand and someone capable of explaining records 10Receive assistance in planning and obtaining post discharge services Informed consent Legally recognized since 1914 Patient understand medical procedures to be performed, its necessity and alternatives and why The benefits Risks and consequences and likelihood Consent freely given Second opinion Insurers require for certain procedures May be patient-generated Guard against unnecessary, inappropriate or non- beneficial procedures Diagnosis Related Groups (DRGs) Hospital Reimbursement Retrospective reimbursement perverse to cost control, fueled utilization Response to over-use, rising costs, corporate outcries Shift to prospective reimbursement reversed financial incentives for overuse of treatments, services Medicare adopted in 1983, other insures followed Discharge planning Arranges post-hospital care Involves physicians, social workers, insurance company and nursing Right of discharge appeal: Medicare designated Quality improvement Organizations (QIOs) protect patient rights to appropriate discharge planning Post DRG and Managed Care: early market reforms Mid 1980s-2000: 2,000 hospital closed, inpatient days fell by 1/3, may consolidated into local/regional/multi0facility systems 1970s-1990s: "production line" concepts to gain efficiencies; research highlighted alienated patients and caregivers 2000-present: refocus on personalized patient care and amenities Horizontal integration: hospital mergers under one of more corporate structures to allow economies of scale, enhanced expert recruitment and deployment, increased access to capital and stronger brand marketing, produce same goods and services Crested in mid 1900s and slowed until 2002 when anticipated reforms refueled consolidations and mergers Vertical integrations: operation of a variety of related businesses, in health care, ideal vertical system encompasses full continuum Primary and specialty diagnosis and treatment Inpatient medical and surgical services Short and long term rehabilitation Long term home and institutional services Terminal care Quality of Hospital care Operational factors, indicators of quality, value judgements Historically: "degree of conformance with preset standards Peer review: implicit criteria with qualitative judgements Avedis Donabedian: created 3 components of medical care: structure, process, outcome Landmark studies revealed wide variations Hospital accreditation by the JCAHO initially structural; moved to process and most recently to outcomes Computerized information and analytical techniques allow adjustment of findings to account for patient variables previously held to confound fair assessments of patient outcomes Variations in medical care: John Wennberg, Alan Gittlesohn: documented variations in the amounts and types of medical provided to patients with the same diagnoses living in different geographic areas Amount and cost of hospital treatment] related more to number, specialties and preferences of physician's than to patients conditions Hazards of hospitalization: IOM report: 44-98,000 annual deaths from errors Due to system deficiencies, not negligent provers Types: diagnostic, treatment, preventive, other procedures Congressional, professional responses rapid, but short- lived Improvement efforts continue with some successes but no "system-wide" uniformity Nursing shortage Crisis Dissatisfaction with staff reductions, overwork, and inability to maintain quality patient care Qualified individuals have many less demanding career options 1/3 of nursing workforce is 50+ years of age; young persons disinclined to enter the profession Shortage improved 2002-2009 with 62% increase in employable RNs Research efforts on quality improvement JCAHO: quantitatively define quality with measurable, results focus Patient-focused hospitals satisfaction studies Studies on test, procedure appropriateness: on average, 1/3 or more of all procedures of questionable benefit Responsibility of governing boards for quality of care Boards carry ultimate responsibility for quality, oversee quality assurance and monitor indicators such as: Mortality rates by department Hospital-acquired infections Patient complaints Adverse drug reactions Hospital-incurred traumas Hospitalists: A rapidly Growing Innovation Substitute for patients' primary physicians Coordinate all in-hospital care Most are qualifies in internal medicine Many assessments underway regarding quality and coordination of care "specialty designation" currently under consideration Forces of Reform Costs, quality, and access are hospital survival criteria of the future Overuse of expensive technology without evidence-based patients benefits will be curtailed Americans are more attuned than ever to shortcomings of the expensive, ineffective health care system Hospital performance will be matters of public judgement based on published outcomes criteria Affordable Care Act on hospitals Population focuses: shift to accountability for overall outcomes of patient care,, not only within "hospital walls," require new levels of coordination Market consolidations: mergers and acquisitions: create new, larger systems for negotiation power with payers, increased efficiencies and control of population groups Accountable care organizations: hospitals join in legal arrangements with physicians, other providers, suppliers to coordinate patient care across full spectrum of needs Reimbursement and payment revision: ACO shared savings; hospital value-based purchase; readmissions reduction program; bundles payment for care improvement initiative Continuing Change Retain core roles Technology advanced care Education of physicians and other health professional Clinical research sites Advances into new role One component of integrated systems in continuum of community-based care Results of government and private entity experiments with hospital roles in a population-focuses, value- driven delivery system will inform about refinements affecting costs and quality Rising concerns about ACOs joining prior competitors, creating market power that may drive up costs Positive reports of consolidation hospital system note that system member hospitals outperform and improve faster than independent hospitals on important quality parameters Likely to be variation in capability of individual hospitals to adjust to reforms; not all will survive
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