Integrated Health Care Delivery Systems

• Health care system has six levels of care.
• The six levels of care are preventive, primary, secondary, tertiary, restorative, and continuing health care.
• Levels of care describe the scope of services and settings delivered to patients in all stages of health and illness.
• Levels of care are not the same as levels of prevention.
• Levels of prevention involve health-related activities in a care setting.
• Levels of prevention include health promotion and disease prevention (primary prevention).
• Levels of prevention include curing or managing disease (secondary prevention).
• Levels of prevention include reducing complications (tertiary prevention).

Examples of Health Care Services

• Preventive care includes adult screenings for blood pressure, cholesterol, tobacco use, and cancer.
• Preventive care includes pediatric screenings for hearing, vision, autism, and developmental disorders.
• Preventive care includes HIV screening for adults at higher risk.
• Preventive care includes wellness visits, immunizations, and diet counseling.
• Preventive care includes mental health counseling and crisis prevention and community legislation.
• Community legislation includes seat belts, car seats for children, and bike helmets.
• Primary care (health promotion) includes diagnosing and treating common illnesses.
• Primary care includes managing chronic health problems and prenatal and well-baby care.
• Primary care includes family planning and patient-centered medical home care.
• Secondary (acute) care includes urgent care and hospital emergency care.
• Secondary care includes acute medical-surgical care, such as ambulatory care, outpatient surgery, and hospital care.
• Secondary car includes radiological procedures.
• Tertiary care is highly specialized through intensive care and inpatient psychiatric facilities.
• Tertiary care involves specialty care such as neurology, cardiology, rheumatology, dermatology, and oncology.
• Restorative care involves rehabilitation programs, sports medicine, and spinal cord injury programs.
• Restorative care involves home care.
• Continuing care involves long-term care, assisted living, and nursing centers.
• Continuing care includes psychiatric and older-adult day care.

Integrated Health Care Delivery (IHCD)

• Defined as a network of health care organizations working together.
• Aims to provide a continuum of health services to a defined population.
• Strives to align resources, improve quality, and control costs.
• Primary focus on improving health care quality and decreasing overall health care costs.
• Goal to decrease health care costs through effective management of patients with chronic health problems.

Primary and Preventive Health Care Services

• Focuses on improved health outcomes for an entire population.
• Promotes regular health care visits, health education, proper nutrition and maternal/child health care.
• Includes family planning, immunizations, and control of diseases.

Secondary and Tertiary Care

• Secondary health care is provided by a specialist or agency on referral by a primary health care provider.
• Requires more specialized knowledge, skill, or equipment than primary care.
• Tertiary health care is specialized consultative care usually provided on referral from secondary medical personnel.

Hospitals

• Provide comprehensive secondary and tertiary health care to acutely ill patients.
• Services vary; small rural hospitals offer general inpatient services.
• Typically have limited emergency and diagnostic services.

Intensive Care

• ICU or critical care unit (CCU) is a hospital unit.
• Patients receive close monitoring and intensive medical and nursing care.
• Health care providers in ICUs must have specialized knowledge and skills.
• Patient status can change by the minute for critically ill individuals.

Mental Health Facilities

• Located in hospitals, independent outpatient clinics, and private mental health hospitals.
• Offer inpatient and outpatient services, depending on the severity of the patient's problem.
• Patients enter voluntarily or involuntarily.

Rural Hospitals

• Lack of health care access in rural areas is a serious public health problem.

Discharge Planning

• A coordinated, interprofessional process that develops a continuing care plan after a patient leaves a health care agency.
• Discharge instructions prepare patients for transition from a hospital to the next level of care.
• Transitions to home, rehabilitation, or long-term care.

Restorative Care

• Aims to help individuals regain maximal functional status.
• Strives to enhance quality of life through promotion of independence and self-care.
• Some patients require ongoing wound care, activity, and exercise management after surgery.

Home Care

• Provision of medically related professional and paraprofessional services and equipment to patients and families.
• Services provided in their homes for health maintenance, education, illness prevention, diagnosis, treatment, rehabilitation, and palliative care.
• Focuses on helping patients and their family members achieve independence and addresses the recovery and stabilization of an illness.

Rehabilitation

• The WHO defines rehabilitation as the process aimed at enabling people with disabilities to reach and maintain their optimal physical, sensory, intellectual, psychological, and social functional levels.
• Provides tools people with disabilities need to attain independence and self-determination.

Extended Care Facilities

• Provide intermediate medical, nursing, or custodial care for patients recovering from acute illness or with chronic illnesses or disabilities.
• Include intermediate care and skilled nursing facilities.
• Some may also have long-term care and assisted-living facilities.

Continuing Care

• Describes a variety of health, personal, and social services provided over a prolonged period.
• For people with disabilities, who were never functionally independent, or terminal illnesses.
• Available within institutional settings (nursing centers, nursing homes, group homes, and retirement communities).
• Community settings (adult day care and senior centers) and at home (home care, home-delivered meals, and hospice).

Issues in Health Care Delivery for Nurses

• Health care agencies work hard to improve patient experience and engagement while delivering high-quality care.
• Agencies also work to improving outcomes and keeping costs under control.
• Managing costs and achieving high-quality patient care are two initiatives impossible to separate.
• Nursing shortage affects all aspects of nursing.
• Shortage affects patient care, administration, and nursing education, but it presents challenges for the profession.

Competency in Nursing

• The Quality and Safety Education for Nurses (QSEN) project developed quality and safety competencies.
• Aims to give nurses the appropriate knowledge, skills, and attitudes to meet the challenges in today's health care settings.

Patient-Centered Care

• "Care that is respectful of and responsive to individual patient preferences, needs, and values and ensures that patient values guide all clinical decisions”.

Technology in Health Care

• Technological advances continually affect health care organizations.
• Advances change the ways nurses deliver evidence-based care to patients.
• Technology makes your work easier but should not replace clinical judgment and decision-making.

Health Care Disparities

• Involve differences in health care outcomes and dimensions of health care.
• Include differences in access, quality, and equity among population groups.
• Disparities can be related to race, ethnicity, gender, location, disability, and social determinants.

Philippine Health Care Delivery System

• Composed of 2 sectors: public and private.

Public Sector (Philippines)

• Financed by the government, health care is generally free at the point of service.

Private Sector (Philippines)

• Owned, controlled, and managed by individuals, groups, or business entities.
• Health care is paid through user fees at the point of service.

Public Sector (Philippines) - Executive Order (EO) 102

• Identifies DOH as the national authority on health.
• DOH provides technical and other resource assistance to concerned groups.
• DOH takes roles related to leadership in health, enabler and capacity builder, and administrator of specific services.

Public Sector (Philippines) - RA 7160 (Local Government Code)

• Transfers responsibility for delivering basic services and facilities to local government.
• Local agencies are including health services and facilities.
• Local governments are self-reliant and active partners in the attainment of local goals through responsive local government structure.

This lesson explores integrated health care delivery (IHCD) systems and their goals. It covers levels of health care, prevention strategies, and the importance of prioritizing population health. It also touches on factors contributing to health care disparities.