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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
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