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ATI Module
Health Care Delivery (Exam 1)
| Question | Answer |
|---|---|
| Affordable Care Act (ACA) | A law enacted in 2010 to improve health care quality while lowering costs and expanding the Medicaid program. |
| American Nurses Credentialing Center (ANCC) | An organization that supports nurses to improve client care through education, certifications, and professional designations. |
| assisted living | Provides services for clients who are mostly independent in their living but who choose to live in a community setting for assistance with some part of their daily life |
| Centers for Medicare & Medicaid Services (CMS) | A government agency that oversees the health care delivery of Medicare, Medicaid, and CHIP programs. |
| Children’s Health Insurance Program (CHIP) | Government health care coverage that provides for children who may not meet Medicaid's requirements but need health coverage |
| diagnosis-related groups (DRGs) | A fixed payment system for reimbursement for health care services based upon client diagnosis and procedures performed. |
| fee for service (FFS) | Reimbursement payments made to service providers based on the volume of services delivered. |
| home care | The delivery of continued health care services within the client's home. Services can include nurse visits as well as occupational therapy, physical therapy, and social work. |
| hospice care | Services provided to clients when it is determined the client has less than six months to live. The goal is comfort and support services for the client and family, not curative. |
| Hospital-Acquired Condition Reduction Program (HACRP) | A program instituted by the Centers for Medicare & Medicaid (CMS) to increase the quality of care in health care facilities. This program denies reimbursement for services associated with specific health care-acquired infections. |
| hospital-acquired infections (HAIs) | An infection a client develops during an admission to an acute care facility. |
| inpatient prospective payment system (IPPS) | A method of standardized insurance reimbursement based on the client’s diagnosis and procedures performed within the acute care setting. |
| long-term care hospital (LTCH) | A facility that specializes in providing care for stable clients who require a lengthy period of treatment, such as for severe burns, trauma, or ventilation needs. |
| Magnet Recognition Program® | A program that recognizes acute care facilities that demonstrate excellence in nursing based upon meeting standards in five categories. |
| Medicaid | Government health care coverage for a client who must meet eligibility requirements based on the client's income in relation to the poverty level. |
| Medicare | Government health care coverage for a client who is age 65 or older, under age 65 with disabilities, or any age with end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS). |
| Minimum Data Set (MDS) | A clinical assessment of a client's physical and cognitive status required to be conducted on nursing home residents who receive Medicare and Medicaid benefits. |
| National Committee for Quality Assurance (NCQA) | An organization that focuses on improving the quality of health care through the development of evidence-based standards for care. |
| palliative care | Services provided to clients to promote comfort while in the last stages of life. |
| Pathway to Excellence Program® | A program for long-term or outpatient facilities to recognize excellence in nursing. |
| Press Ganey® | A survey tool designed to evaluate the client's perception of their experience within the outpatient setting of the health care syst |
| private insurance | Insurance coverage that is not provided by a government agency. |
| resource utilization groups (RUGs) | A fixed payment system for reimbursement of health care services provided in the long-term care setting based upon client diagnosis and services required. |
| respite care | Allows the client to be cared for apart from the caregiver, to allow the caregiver a break from the responsibilities of client care for a short time for vacations to travel or to simply stay at home without caring for the client. |
| sentinel event | An adverse event that should never occur. |
| skilled nursing facility (SNF | Sometimes referred to as a nursing home or long-term care, may provide for short term rehabilitation care such as occupational and physical therapy as well as oversight for activities of daily living. |
| social determinants of health (SDOH) | The conditions in the environments where people are born and live that affect their health, well-being, and quality of life. |
| The components of the Magnet Program model | Structural empowerment Exemplary professional practice New knowledge, innovations, or improvements Transformational leadership Empirical outcomes |
| Structural empowerment | administration empowers nurses to work together with community and organizational entities to accomplish organizational goals and promote best practices. requires that the organization has a strategic plan, with systems, policies, and goals |
| New knowledge, innovations, and improvements | suggest that organizations form new ideas and are actively engaged in implementing and producing EBP research. Creating new and better models of care is essential to moving the organization forward. |
| Exemplary professional practice | means that the nurse is safe in practice. It also means the nurse strives to apply new information and evidence-based practice (EBP). |
| Transformational leadership | involves having a visionary leadership team that is not satisfied with a stagnant organization. Instead the team leads the organization to learn and grow together, constantly questioning how the organization can be better. |
| Empirical outcomes | are the report card of the organization. Data from the workforce, from client outcomes, and from organizational outcomes show how the organization achieves excellence. |
| Magnet Recognition Program identifies | - Organizations with quality outcomes - Client Care Excellence - innovations in professional practice |
| Pathway to Excellence Identifies | - contribution that affect nurses will being - Shared government Structure - Supportive practice environment. |
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