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Transitions in OT

Management Skills Chapter 9,5,8,6

Fee for Service- Dr. orders service, submits bills, insurance pays.
Managed Care HMO, PPO manages, limits and sets rules for obtaining services, through referrals, networks, and PCP.
Capitation a cap on services that is predetermined statistically and given to PCP per each beneficiary.
PPS-Prospective Payment System System of payment that predetermines what will be paid based on a set of criteria, DRG and RUG's are examples
DRG Diagnostic Related Group- classification of a condition, based on diagnosis, age, gender, existing medical conditions that is used to determine the type duration, and amount of treatment that will be reimbursed. Inpatient.
TEFRA Limited Mcare A by establishing DRG's. Established guidelines for rehab units and reimbursement.
Where do guidelines come from? JCAHO -Joint Commision on the Accredidation of Hospitals, CARF-Commission on the Accreditation of Rehabilitation Facilities, state licensure requirements, and standards of practice.
Medicare/Medicaid Part A Inpatient Therapy, Hospital
Medicare/Medicaid Part B Outpatient and home care- Medical Insurance
RUG Resource Utilization Groups- Similar to DRG a type of PPS classifying conditions into catergories using the MDS instrument. Each category specifies the amount of therapy min. Uses MDS to determine level of care at SNF and TCU
MDS Minimum Data Set- assessment instrument that combines med info and current functional status to determine level of care at facility ex. SNF
RAP Resident Assistant Protocols, like the MDS but goes further the preliminary assessments.
OASIS Outcome and Assessment Information Set, HHA standard Assessment
Capital Budget amount of money and org. or dept. allocates for long term and large equipment. Cost of over $300, and used for a year or longer
Operational Budget daily basis expenses, supplies for services. Forms, materials, etc.
DX Coding Diagnosis, who you treated
CPT (HCPS Codes) Procedures, what you did
Why is EBP important Validates treatment choice, helps patient compliance and helps to get payment.
Control Group The group of participants that does not receive the independent variable
Dependent variable The outcome or change that is expected
Experimental/Intervention Group The group that receives the independent variable
External Validity The results obtained in the study can be generalized back to the population
Hypothesis prediction of the relationship between variables or the outcome of an investigation
Independent Variable A variable that is thought to influence the outcome of the study
Active Independent Variable One that is given to the participant and applied, such as an intervention
Attribute Independent Variable a pre-exsisting characteristic of the participants thought to have an influence.
Internal Validity term that indicates the dependent variable is a result of the independent variable
Population an group of people or objects that meet a specified criteria relevant to the research
Reliability ability of a measure to achieve the same results over time. Interater, test retest
Significance indicates that statistically the independent variable, is likely related to the dependent variable
Validity a statistical term that indicates the findings of the study are correct
Quantitative Research Traditional, based on concrete numbers and statistics.
Qualitative Research Goal is to explore meaning and interpretation of experience, discover themes that emerge.
Quality Management Methods clinical audits, peer reviews, accredidation
Clinical Audits group of peers working to review case records for adherence to pre-established standards
Peer Review type of record review based on criteria established by the individual department for quality care
Process criteria the activities or procedures undertaken as part of good patient care
Accreditation sought by hospitals for proof of providing services that meet guidelines of Medicare
QA- Quality Assurance externally driven, self-orientated, vertical, delegated to a few, focused on people, hiding problems, seeks endpoints
QAI- Quality Assessment Improvement internally motivated, customer driven, horizontal, embraced by all, focused on processes, seeking problems, has no end point
PI- Performance Improvement internal and externally driven, customer/data driven, organization wide, embraced by all, focuses on process, system and function, seeks improvement using benchmarks or comparative data, no endpoint.
NBCOT PDU Requirement 36 PDU's over a 3 year period to maintain certification and credentials
Directive Supervisory style where the supervisor tells supervisee what to do, when to do it, where to do it and how.
Supportive supervisory style where supervisor listens, encourages, and facilitates decision making and performance
Directing high direction, low support
Coaching high direction, high support- most appropriate with new grads
Supporting low direction, high support
Delegating low direction, low support
AOTA Entry Level Less then 1 year in practice, requires close supervision
AOTA Intermediate Level 1-3 Years of practice, requires routine or general supervision
AOTA Advanced Level 3 or more years in practice, requires minimal supervision
Passive to avoid speaking up for fear of angering someone. Can result in blowing up or stress build up.
Aggressive intimidating, abusive behavior based on only meeting your own needs
Passive Aggressive expressing your thoughts indirectly through behind the scene measures or inappropriate body language. Dysfunctional behavior. Ultimately no ones needs are met.
Assertive Straight forward and kind. Good form of communication.
Modeling a Positive Attitude Stop Criticizing, Block Rumor Spreading, Counter Cynicism
Five steps in Communicating Feedback Identify Goal, Make it Safe, Share your perspective, Clarify what you both heard, Have an agreement going forward.
Close Supervision Daily, direct contact
Routine Supervision direct contact every two weeks, with interim supervision as needed
General supervision direct contact at least every month, interim as needed
Minimal supervision On an as-needed basis
Continuous Supervision Direct on site supervision at all times
Ethnographic research type of qualitative research Describes the culture, points of view, and meanings of the people from that culture
Phenomenological research Type of qualitative research that strives to understand and explain the true-life experiences of people as they understand them
Grounded Theory Type of qualitative research that develops theory from analysis of gathered data.
Steps in Quantitative Research Form hypothesis, determine protocol, research proposal is reviewed, participants selected,study is carried out, data is analyzed, results are written up.
Created by: kokokachoo