basic health care

1. THE NURSE’S
ROLE IN
HEALTHCARE
QUALITY AND
PATIENT
SAFETY
PROF. LEON

2. Challenges
to Health
Care
2
Uninsured patients
Reducing health care costs while maintaining
high-quality care for patients
Improving access and coverage for more
people
Encouraging healthy behaviors
Earlier hospital discharges result in more
patients needing nursing homes or home care

3. National
Priorities
Partnership
Promote best practices
Promote
Promote prevention, treatment, and intervention practices for
the leading causes of mortality
Promote
Ensure person- and family-centered care
Ensure
Make care safer
Make
Promote communication and care coordination
Promote
Make quality care affordable
Make

4. Emphasis on
Population Wellness
• Health Services Pyramid
• Managing health instead of
illness
• Emphasis on wellness
• Injury-prevention programs
4

5. Health Care Settings and Services
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1. Preventive 2. Primary
3. Secondary 4. Tertiary
5. Restorative 6. Continuing

6. Preventive
and
Primary
Health Care
6
Preventive Care
• Reduces and controls risk factors for disease
Primary care
• Focuses on improved health outcomes
• Requires collaboration
Health promotion programs lower overall
costs
• Reduces incidence of disease
• Minimizes complications
• Reduces the need for more expensive resources

7. Secondary
and
Tertiary
Care
7
Focus: Diagnosis and treatment of
disease
Disease management is the most
common and expensive service of
the health care delivery system
Postponement of care by uninsured
contributes to high costs

8. Restorative Care
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Serves patients
recovering from an
acute or chronic
illness/disability
Helps individuals
regain maximal
function and enhance
quality of life

9. Restorative
Care:
Rehabilitation
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Includes physical, occupational, and
speech therapy, and social services
Begins on admission
Focuses on preventing complications
Maximizes patient function and
independence

10. Continuing
Care
10
For people who are disabled,
functionally dependent, or suffering a
terminal disease
Available within institutional settings
or in the home:
• Nursing centers or facilities
• Assisted living
• Respite care
• Adult day care centers
• Hospice

11. Care
Coordination
Accountable care
organizations (ACOs)
• Developed to
coordinate medical
care
• Nurses act as
leaders and care
coordinators
Patient-centered
medical home
(PCMH)
• Coordinates care,
gathers clinical data,
monitors patient
outcomes
• Primary care
providers function
as the hub of the
PCMH

12. Health Care Regulation and Reform
• Regulatory and competitive approaches
• Professional standards review organizations (PSROs)
• Created to review the quality, quantity, and cost of hospital care provided through
Medicare and Medicaid
• Utilization review (UR) committees
• Review admissions, diagnostic testing, and treatments ordered by physicians who
cared for patients receiving Medicare
12

13. Health Care
Regulation
and Reform
• Patient Protection and Affordable Care Act
• Access to health care for all
• Reducing costs
• Improving quality
• Provisions include
• Insurance industry reforms
• Increased funding for public programs
• Improved coverage for children
13

14. Institute of Medicine (IOM)
• Nurses need to be transformed by:
• Practicing to the full extent of their training
• Achieving higher levels of education through an education system that
provides seamless progression
• Becoming full partners with physicians and other health care providers in
redesigning the health care system
• Improving data collection and the information infrastructure for effective
workforce planning and policy making
14

15. Issues in
Health Care
Delivery
15
Magnet Recognition Program
• Nursing-sensitive outcomes
Nursing informatics and
technological advancements
Globalization of health care
• Vulnerable populations

16. Issues in
Health Care
Delivery
16
Nursing shortage
Competency
Quality and safety in health
care
• Pay for performance
• Patient satisfaction

17. Quality and Performance
Improvement
• Quality data
• Quality improvement (QI)
• Performance improvement (PI)
• Quality improvement programs
• Models
• Patient Self-Determination Act (PSDA)
• Six Sigma or Lean
• Rapid-cycle improvement or rapid-improvement event
(RIE)
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18. The Future
of Health
Care
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Change opens up opportunities for improvement.
Health care delivery systems need to address the
needs of the uninsured and the underserved.
Health care organizations are striving to become
better prepared to deal with these and other
challenges in health care.
The solutions necessary to improve the quality of
health care depend largely on the active
participation of nurses.