Utilization Review Committees (UR)
A physician-supervised utilization review committees to review admissions, diagnostic testing, and treatments provided by physicians or health care providers to patients to any facility that is Medicare-quality.
Professional Standards Review Organization (PSROs)
created by the federal government (medicare & medicaid) to review the quality, quantity, and cost of hospital care.
Prospective Payment System (PPS)
eliminates cost-based reimbursement
Diagnosis-related group (DRGs)
Diagnostically related groups of patient; a DRG includes patients whose diagnoses are related,usually by body system or broad disease type, such as heart disease
Capitation
the payment mechanism by which providers receive a fixed amount per patient or enrollee of a health care plan.
Resource Utilization Groups (URGs)
used in long term care settings.
health services pyramid
A model of improving health care.
Disease Prevention
activities that protect people from becoming ill because of actual or potential health threats
Health Promotion
activities that develop human attirtudes and behaviors to maintain or enhance well-being; key quality health care. To keep people healthy through personal hygiene, good nutrition, clean living environments, regular exercise, rest and the adoption of posit
Managed Care
health care systems in which there is administrative control over primary health care services for a defined client population. The provider or health care system receives a predetermined capitated payment for each client enrolled in the program.
Primary Care
provision of integrated, accessible health care services by health care professionals who address a majority of personal health care needs, develop partnerships with clients, and care for families and communities
Primary health Care
combination of primary and public health care that is accessible to individuals and families in a community and provided at an affordable cost
Primary Prevention
health-promoting behaviors or activities that reduce the occurrence of an illness
Public Health
community and interdisciplinary care aimed at preventing disease and promoting health
Secondary Prevention
early diagnosis and treatment of illness (ex: screening for hypertension)
Tertiary Prevention
care that prevents further progression of disease
Preventative
Disease prevention; screenings; immunizations; Is more disease oriented and focuses on reducing and controlling risk factors for disease through activities such as immunizations and occupational health programs.
Primary
Health Promotion; teaching nutrition; Excercise classes; family planning
Secondary
Emergency care and acute care; radiological procedures
Tertiary
Intensive Care Unit; Subacute care
Restorative
Rehab, home care, sports medicine; requires a multidisciplinary team approach.
Continuing Care
Assisted living, psychiatric and older adult day care
home health nurses
focus on client and family independence; provide wound care, vitals, elimination needs, nutrition, rehab, medication administration, IV therapy;
Rehabilitation
attempts to restore clients to their fullest physical, mental, social, vocational and economic potential; includes physical, occupational, and speech therapy; occurs in many health care settings.
Extended Care Facility
Provides intermediate medical, nursing or custodial care for clients recovering from acute illnesses or disabilities
Skilled Nursing Facility
Provides care for clients until they can return to their community or residential care
Continuing Care
For people who are disabled, functionally dependent, or suffering a terminal disease; available in institutional settings or within the home.
Nursing Centers (homes)
can be temporary or permanent; 5% of those over 65 yrs live in nursing centers; need their ADL's met; provides 24 hours intermediate and custodial care.
intermediate care
facility that consists of 24-hour care necessitating nursing supervision, but usually not an intense level
Respite Care
a service that provides short term relief or time off for persons providing home care to an ill, disabled, or frail older adult.
Assisted Living
Offers a long term care setting with a home environment and greater resident autonomy; provides assistance with laundry, housekeeping, nutrition and 24 hour oversight; allows residents to live in their own units.
Hospice
Family centered care that allows clients to live and remain at home. Focuses on comfort, independence and dignity. Provides client and family support during terminal phase and with the time of death. Available 24/7.
Integrated Delivery Networks (IDNs)
includes a set of providers and services organized to deliver a continuum of care to a population of clients at a capitated cost in a particular setting. Reduces duplication of services across levels or settings of care to ensure that clients receive care
Medicare
federally administrated program; for people 65 years and older. Payment for plan deducted from monthly social security check. covers services of nurse practitioners. does not pay full cost of certain services. supplemental insurance is encouraged.
Medicaid
Federally funded, state-operated program that provides: health insurance to low income families, health assistance to low income people with long term care disabilities and supplemental coverage and long term care assistance to older adults and medicare b