Chapter 5 Transforming the Public’s Healthcare Systems Evolving U.S. Healthcare Delivery System Healthcare delivery system Transforms resources into essential services to meet the healthcare needs of certain populations Settings Hospitals Physicians’ offices Shelters Specially equipped vans or shopping malls Evolving U.S. Healthcare Delivery System (cont.) Reimbursement Private insurance companies Managed care organizations Government agencies Foundations Patient Affordable Care Act (ACA) of 2010 Types of healthcare systems Private Public Military Private Healthcare Delivery Fee-for-service Hill-Burton Act Tax Equity and Fiscal Responsibility Act of 1982 1983 Amendments to the Social Security Act Diagnosis-related groups (DRGs) Prospective payment system (PPS) Third-party payers Insurance companies Health maintenance organizations (HMOs) Preferred provider organizations (PPOs) Managed care organizations (MCOs) Public Health Care Defined as the health outcomes of a group of individuals Shattuck 1850 Report of the Sanitary Commission of Massachusetts 1872 Public Health Association formed Social Security Act of 1935 Local health departments Centers for Disease Control and Prevention (CDC) Military Health Care National Defense Authorization Act (2005) Care provided: Ambulatory care Military base and regional clinics Hospital service Base dispensaries or sick bays Simple hospitals services Regional hospitals Advanced care Types of programs TriCare Veterans Administration Healthcare Reform Legislative initiatives were proposed seven times during the 20th century Based on the need to control healthcare costs while providing access to quality healthcare services Nursing and healthcare reform ACA Current U.S. Healthcare Delivery System Interrelated systems Horizontal and vertical integration of services Levels of care Preventive care Primary care Secondary care Tertiary care Restorative care Healthcare Providers Physicians Nurses Physician assistants Specialized care providers Technicians/therapists Other providers Pharmacists Social workers Healthcare Settings Acute care facilities Short-term specialized care facilities Long-term care facilities Ambulatory care sites Daycare centers Hospices Retirement communities Complementary/alternative health care Issues Affecting the Delivery of Healthcare Services Deregulation Emphasis on secondary and tertiary healthcare services Increasing consumerism Technological advances Increasing longevity of Americans Defensive health care and government regulation Managed Care MCOs Capitation HMOs PPOs Point-of-service plans (POSs) Integrated healthcare systems Patient Care Outcomes Defined as the consequences of care that the patient receives or does not receive Outcome studies Look for trends over time in patient status and adverse events Data obtained used as a basis for decisions Development of policies and procedures Community-Based Healthcare Settings Shelters in the community ...

1. Chapter 5
Transforming the Public’s Healthcare Systems
Evolving U.S. Healthcare Delivery System
Healthcare delivery system
Transforms resources into essential services to meet the
healthcare needs of certain populations
Settings
Hospitals
Physicians’ offices
Shelters
Specially equipped vans or shopping malls
Evolving U.S. Healthcare Delivery System (cont.)
Reimbursement
Private insurance companies
Managed care organizations
Government agencies
Foundations
Patient
Affordable Care Act (ACA) of 2010
Types of healthcare systems
Private
Public
Military
Private Healthcare Delivery
Fee-for-service

2. Hill-Burton Act
Tax Equity and Fiscal Responsibility Act of 1982
1983 Amendments to the Social Security Act
Diagnosis-related groups (DRGs)
Prospective payment system (PPS)
Third-party payers
Insurance companies
Health maintenance organizations (HMOs)
Preferred provider organizations (PPOs)
Managed care organizations (MCOs)
Public Health Care
Defined as the health outcomes of a group of individuals
Shattuck
1850 Report of the Sanitary Commission of Massachusetts
1872 Public Health Association formed
Social Security Act of 1935
Local health departments
Centers for Disease Control and Prevention (CDC)
Military Health Care
National Defense Authorization Act (2005)
Care provided:
Ambulatory care
Military base and regional clinics
Hospital service
Base dispensaries or sick bays
Simple hospitals services
Regional hospitals
Advanced care
Types of programs
TriCare
Veterans Administration

3. Healthcare Reform
Legislative initiatives were proposed seven times during the
20th century
Based on the need to control healthcare costs while providing
access to quality healthcare services
Nursing and healthcare reform
ACA
Current U.S. Healthcare Delivery System
Interrelated systems
Horizontal and vertical integration of services
Levels of care
Preventive care
Primary care
Secondary care
Tertiary care
Restorative care
Healthcare Providers
Physicians
Nurses
Physician assistants
Specialized care providers
Technicians/therapists
Other providers
Pharmacists
Social workers
Healthcare Settings
Acute care facilities
Short-term specialized care facilities

4. Long-term care facilities
Ambulatory care sites
Daycare centers
Hospices
Retirement communities
Complementary/alternative health care
Issues Affecting the Delivery of Healthcare Services
Deregulation
Emphasis on secondary and tertiary healthcare services
Increasing consumerism
Technological advances
Increasing longevity of Americans
Defensive health care and government regulation
Managed Care
MCOs
Capitation
HMOs
PPOs
Point-of-service plans (POSs)
Integrated healthcare systems
Patient Care Outcomes
Defined as the consequences of care that the patient receives or
does not receive
Outcome studies
Look for trends over time in patient status and adverse events
Data obtained used as a basis for decisions
Development of policies and procedures
Community-Based Healthcare Settings

5. Shelters in the community
Role of nurse
Abuse shelters
Homeless shelters
Disaster shelters
Ambulatory care centers
Ambulatory emergency/trauma
Primary care centers
Ambulatory surgery centers
Health Politics and Policy
Government policy
Healthy People
Healthy People 2020
ACA
Public opinion and special interest groups
Nursing and healthcare policy
American Nurses Association (ANA)
New Nursing Opportunities
Advanced practice registered nurses (APRNs)
Entrepreneurs
Data management and evaluation
Research
Community focused and community based
Prevention and risk reduction focus for all BSN nurses

6. Chapter 4
Epidemiology of
Health and Illness
EpidemiologyThe study of the distribution and the determinants
of states of health and illness in human
populationsEpidemiological model or
triangleHostAgentEnvironment
Scope of EpidemiologyDemographic changesPatterns of
diseaseMethods of control and prevention of health
problemsWellness focus
The Basis for the
Epidemiological Process
Identifying health problems and needs
Collecting and analyzing data to identify risk factors
Planning, implementing, and evaluating methods for prevention
and control
The Epidemiological, Research, and Nursing
ProcessesSimilarities include:Defining the problemGathering
dataAnalyzing the dataEvaluating the data

7. Natural History of DiseasePrepathogenesis periodPathogenesis
periodLevels of preventionPrimary preventionSecondary
preventionTertiary prevention
Descriptive EpidemiologyFocuses on the frequency and
distribution of states of health within a population:
- Person
- Place
- Time
Use of RatesIncidence ratesMortalityPrevalence
ratesMorbidityCrude ratesSpecific ratesAdjusted rates
Sources of DataCensus dataVital statisticsCenters for Disease
Control and Prevention (CDC)Morbidity and Mortality Weekly
Report (MMWR)National Center for Health Statistics
Person, Place, and TimeWho develops the health problemWhere
the rates of the health problem are the highest and lowest can be
determined by examining the characteristics of placeWhen
health problems occurShort-termSeasonal or cyclicalLong-term
Analytic EpidemiologyCross-sectional studiesRetrospective

8. (case-control) studiesProspective studiesIntervention
(experimental) studies
Chapter 7
Global Health
Global Health
Population expansion
Aging population in some areas
Decrease in life expectancy in others (HIV)
High birth rates and poverty
Role of International Agencies
United Nations
Nongovernmental organizations (NGOs)
Carter Center
Bill & Melinda Gates Foundation
United Nations Children’s Fund
World Health Organization
World Bank
Global Health Issues
Disease burden
Infectious diseases
New pathogens
Human immunodeficiency virus (HIV)/acquired immune
deficiency syndrome (AIDS)
Tuberculosis (TB)
Lower respiratory infections
Chronic diseases
Obesity
Cardiovascular diseases
Cancers

9. Diabetes
Chronic respiratory diseases
Violence and War
Levels of violence
Armed conflict and war
Poverty
Women’s rights
Global Initiatives
Declaration of Alma Ata
Millennium developmental goals
Nursing shortages
International Council of Nurses
Nursing and human rights