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Community-Based HealthCare

Community-Based HealthCare. PPP by Marianne McAuley , BSN, MS, RN Revised KBurger1008 LECTURE # 20 FALL 2009. What is Community-Based Health Care?. Part of holistic nursing practice Focuses on primary health interventions – [ preventative health care ]

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Community-Based HealthCare

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  1. Community-Based HealthCare PPP by Marianne McAuley , BSN, MS, RNRevised KBurger1008LECTURE # 20 FALL 2009

  2. What is Community-Based Health Care? • Part of holistic nursing practice • Focuses on primary health interventions – [ preventative health care ] • Considers unique needs of a specific geographic region and population of that community. • Diverse settings – rural, urban, etc.

  3. HEALTHY PEOPLE 2010 • Health care goals for the nation • Increase quality & years of healthy life for Americans • Remove disparities in health care

  4. PUBLIC HEALTH NURSINGUnderstand needs of a population • PUBLIC HEALTH PROBLEMS • Prevalence of overweight • Under immunization of children • Increase of STD • Drug resistant strains of TB • Toxic environmental conditions • New diseases - AIDS, West Nile Virus

  5. Components of a Community Assessment • Population • Demographic census data • Predominant cultural group • Structure • Location of services • Locations where people congregate • Housing • economy • Social System • Transportation system • Health system – gaps in services? • Government

  6. Types of Preventive Services • Primary: • Decrease risk to a client for disease • life-style modifications • Secondary: • Early intervention to alleviate disease • Diagnosis & prompt intervention to decrease severity of a disease • screenings • Tertiary • Minimize effects of chronic conditions • rehabilitation activities

  7. National Public Agencies • U.S. Dept. of Health & Human Services • administratively responsible for public health care services • U.S. Public Health Services • oversees delivery of public services • Veteran’s Administration • health care for members of armed forces

  8. Agencies of USPHS • CDC- prevents transmission of communicable diseases • FDA - Protects public from unsafe drugs, food, cosmetics • NIH – National Institute of Health • conducts research & education for specific diseases • AHRQ – Agency for Health Care Research & Quality • identifies standard of care for high-volume diseases

  9. State and Local Health Departments • New York State Department of HealthNYSDOH • Suffolk County Department of Health SCDOH

  10. Voluntary Agencies • ANA, AMA • American Heart Association • American Cancer Society • Meals on Wheels • Support Groups

  11. ROLES OF THE NURSE • Caregiver • Collaborator • Advocate • Educator • Manager • Change agent • Counselor

  12. FINANCIAL ASPECTS OF HEALTH CARE • US: private insurance model • Past: Retrospective System: fee-for-service • Present: Prospective System: predetermined fixed amounts of payments • Managed Care • Payment System: 1983: Prospective • Diagnosis Related Groups (DRGs) • Length of Stay (LOS)

  13. Managed Care • access, cost & quality are controlled • emphasis on prevention & primary care • not a place, but an organizational structure • primary care physician - gatekeeper

  14. Types of Managed Care • Managed Care Organizations (MCO) - Staff model = physicians employed by the MCO - Group, Network, Independent model = MCO contracts with specific practitioners or groups • capitated rates: a preset flat fee based on membership not services • referral needed for specialists

  15. TYPES OF MANAGED CARE • PPO [ Preferred Provider Organization ] • - members use network of providers • - insurance plans and self-insured employers • members pay extra for providers outside of network • incentive for providers: large # of patients • 42% growth rate in last 10 years

  16. MEDICARE • A type of MCO • Part A: inpatient hospital, skilled nursing facility, home, hospice care • no premium - paid by Federal gov’t • Part B: outpatient costs, physician visits • paid by monthly premium • Part D: [ as of 1/06] prescription coverage Part D: [ as of 1/06] prescription coverage

  17. MEDICAID • For people with low income • Jointly administered by Federal government & states • Each state determines eligibility & services • 90% of long-term care (nursing centers) paid by Medicaid

  18. ISSUES IN HEALTH CARE • Cost • oversupply of specialized providers • focus on treatment of disease, not prevention • surplus of hospital beds • consumers are passive • aging of population • advanced technology • lawsuits

  19. ISSUES IN HEALTH CARE • Access • more likely to develop health problems • poorer outcomes • Vulnerable Populations-Poor-Homeless-Abused-Substance Dependent-Elderly-Immigrant -Mentally Ill • Proper assessment requires non-judgmental and culturally competent attitudes. Critical thinking!

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