Copyright © 2008 Delmar Learning. All rights reserved. Unit 1 Community Health Care

Copyright © 2008 Delmar Learning. All rights reserved. Objectives Spell and define terms. List the five basic functions of health care facilities. Describe four changes that have taken place in health care in the last few years. Describe the differences between acute care and long-term care.

Copyright © 2008 Delmar Learning. All rights reserved. Objectives Name the departments within a hospital. Describe the functions of the departments within a hospital. Explain three ways by which health care costs are paid. State the purpose of health care facility surveys.

Copyright © 2008 Delmar Learning. All rights reserved. Introduction Health care facilities have five basic functions: –Provide services for the ill and injured –Prevent disease –Promote individual and community health –Educate health care workers –Promote research in medicine and nursing

Copyright © 2008 Delmar Learning. All rights reserved. Overview of Health Care Health care emphasizes patient-focused care Many changes have occurred in health care in the last few years

Copyright © 2008 Delmar Learning. All rights reserved. Overview of Health Care There are several reasons for these changes –People are living longer –Technology is becoming more advanced –Health care costs have increased –Many ethical questions that must be answered by health care providers and consumers

Copyright © 2008 Delmar Learning. All rights reserved. Overview of Health Care Managed care means the insurance company will: –Not permit certain procedures or diagnostic tests until they have been approved by the insurer.

Copyright © 2008 Delmar Learning. All rights reserved. Overview of Health Care Managed care means the insurance company will: –Negotiate with specific physicians, hospitals, pharmacies, and other care providers to render services at a lower cost to the company’s members.

Copyright © 2008 Delmar Learning. All rights reserved. Overview of Health Care Managed care means the insurance company will: –Approve only a certain number of days of hospitalization for specific diagnoses. –Require that specific procedures be done on an outpatient basis rather than having the patient admitted to the hospital.

Copyright © 2008 Delmar Learning. All rights reserved. Needs of the Community Health care is needed throughout life Short-term or long-term care includes: –Preventive –Emergency –Surgery –Rehabilitation –Hospice care

Copyright © 2008 Delmar Learning. All rights reserved. Preventive Care Prenatal care –Care of mother during pregnancy Well-baby checkups and immunizations Health education to teach individuals how to avoid disease and injury Physical examinations throughout life

Copyright © 2008 Delmar Learning. All rights reserved. Emergency Care Short-term care given for sudden illness or injury Surgery –To repair an injured body or remove a diseased organ

Copyright © 2008 Delmar Learning. All rights reserved. Rehabilitation To help a patient regain abilities after an illness or injury Long-term care –For persons who have chronic or incurable conditions

Copyright © 2008 Delmar Learning. All rights reserved. Hospice Care For patients who are dying and their families

Copyright © 2008 Delmar Learning. All rights reserved. Needs of the Community People receiving health care are called health care consumers –Identified by type of care they need

Copyright © 2008 Delmar Learning. All rights reserved. Needs of the Community Patient –Persons in acute care facilities, such as hospitals Client –Persons receiving care in their own homes Resident –Persons in long-term skilled care facilities

Copyright © 2008 Delmar Learning. All rights reserved. Types of Health Care Facilities Short-Term CareLong-Term Care HospitalsSkilled care facilities Urgent care facilitiesAdult day care SurgicentersAssisted living facilities Rehabilitation centers Psychiatric hospitals Outpatient clinicsRespite care Psychiatric hospitals Physician’s officesHome care

Copyright © 2008 Delmar Learning. All rights reserved. Long-term Acute Care Hospitals Fully licensed hospitals in which a lengthy stay is anticipated Provide a higher level of care than other chronic care settings

Copyright © 2008 Delmar Learning. All rights reserved. Long-term Acute Care Hospitals Patients must have a medically-complex condition –Need acute care services –Have a good chance of improvement

Copyright © 2008 Delmar Learning. All rights reserved. Magnet Hospitals Magnet Program for Excellence in Nursing Services –Based on quality indicators and nursing practice standards

Copyright © 2008 Delmar Learning. All rights reserved. Magnet Hospitals Program is voluntary and recognizes hospitals for nursing excellence Hospitals who have been awarded magnet status are usually progressive –Desirable places to work

Copyright © 2008 Delmar Learning. All rights reserved. Community Health Care Services Hospitals –Most hospitals are licensed to care for patients of all ages and with a variety of problems –Some hospitals take care of patients with special conditions or care for specific age groups

Copyright © 2008 Delmar Learning. All rights reserved. Community Health Care Services Pediatric hospitals –Care for children from birth to 18 years Psychiatric hospitals –Provide care for persons with mental illness Rehabilitation hospitals –Provide restorative services to patients following disease, illness, or injury

Copyright © 2008 Delmar Learning. All rights reserved. Community Health Care Services Hospital organization –Provide the most efficient delivery of service –Major departments established within each facility Care for patients with specific conditions 24 hours a day, 7 days a week

Copyright © 2008 Delmar Learning. All rights reserved. Community Health Care Services Hospital organization –Surgical department Cares for patients before, during, and after surgery –Pediatric department Cares for sick and injured children

Copyright © 2008 Delmar Learning. All rights reserved. Community Health Care Services Hospital organization –Obstetric department Cares for newborns and their mothers –Emergency department Cares for victims of trauma, natural disasters, or medical emergencies

Copyright © 2008 Delmar Learning. All rights reserved. Community Health Care Services Hospital organization –Critical care department Cares for seriously ill patients who require constant monitoring and care

Copyright © 2008 Delmar Learning. All rights reserved. Community Health Care Services Hospital organization –Medical department Cares for patients with medical conditions such as pneumonia or heart disease

Copyright © 2008 Delmar Learning. All rights reserved. Community Health Care Services Hospital organization –Larger hospitals –Many specialized units staffed by nurses and therapists Trained to care for persons with specific problems

Copyright © 2008 Delmar Learning. All rights reserved. Specialized Services Dietary Pharmacy Diagnostic –Pathology (study of disease) –Diagnostic imaging and radiology –Laboratory

Copyright © 2008 Delmar Learning. All rights reserved. Specialized Services Rehabilitation services –Physical therapy –Occupational therapy –Speech therapy –Respiratory therapy –Social services

Copyright © 2008 Delmar Learning. All rights reserved. Specialized Services Environmental services –Housekeeping –Maintenance –Laundry

Copyright © 2008 Delmar Learning. All rights reserved. Specialized Services Business services Medical records department Volunteer services Pastoral services

Copyright © 2008 Delmar Learning. All rights reserved. Financing Health Care Health care is paid for by: –Insurance –Out-of-pocket payments –Medicaid State and federal government program Pays for persons of any age who do not have financial resources for health care

Copyright © 2008 Delmar Learning. All rights reserved. Financing Health Care Medicare is a federal government program –Pays a portion of health care costs for persons 65 years and older For younger persons permanently disabled and qualify for benefit

Copyright © 2008 Delmar Learning. All rights reserved. Financing Health Care Medicare payment is based on: –Diagnosis related groups (DRGs) Actual cost of care is not considered

Copyright © 2008 Delmar Learning. All rights reserved. Financing Health Care Rather, Medicare set the payment rates: –Based on data from studies that determined the average length of stay –Required for various medical diagnoses, procedures, and treatments

Copyright © 2008 Delmar Learning. All rights reserved. Regulatory Agencies Joint Commission for Accreditation of Healthcare Organizations (JCAHO) –Inspects and accredits health care agencies –Participation is voluntary –Hospitals are not eligible to receive Medicare payment unless they are JCAHO accredited

Copyright © 2008 Delmar Learning. All rights reserved. Regulatory Agencies Occupational Safety and Health Administration (OSHA) –Surveys health care facilities –Protects health and safety of employees

Copyright © 2008 Delmar Learning. All rights reserved. Quality Assurance All health care facilities have a program called quality assurance (QA) –Identifies problems and finds solutions for improvement