Integrated Health Care Delivery Systems

• Health care system levels of care include preventive, primary, secondary, tertiary, restorative, and continuing health care.
• Levels of care describe the scope of services and settings by health care providers to patients in all stages of health and illness.
• Levels of prevention describe the focus of health-related activities in a care setting.
• These include health promotion and disease prevention as primary prevention.
• Curing or managing disease is secondary prevention.
• Reducing complications is tertiary prevention.

Examples of Health Care Services By Level

• Preventive Care includes:
  • Adult screenings for blood pressure, cholesterol, tobacco use, and cancer
  • Pediatric screenings for hearing, vision, autism, and developmental disorders
  • HIV screening for adults at higher risk
  • Wellness visits
  • Immunizations
  • Diet counseling
  • Mental health counseling and crisis prevention
  • Community legislation such as seat belts, car seats for children, and bike helmets
• Primary Care (Health Promotion) includes:
  • Diagnosis and treatment of common illnesses
  • Ongoing management of chronic health problems
  • Prenatal care
  • Well-baby care
  • Family planning
  • Patient-centered medical home care
• Secondary (Acute Care) includes:
  • Urgent care and hospital emergency care
  • Acute medical-surgical care such as ambulatory care, outpatient surgery, hospital.
  • Radiological procedures
• Tertiary Care includes:
  • Highly specialized care, such as intensive care and inpatient psychiatric facilities.
  • Specialty care such as neurology, cardiology, rheumatology, dermatology, & oncology
• Restorative Care includes:
  • Rehabilitation programs such as cardiovascular, pulmonary, and orthopedic.
  • Sports medicine, spinal cord injury programs, and home care
• Continuing Care includes:
  • Long-term care, assisted living and nursing centers
  • Psychiatric and older-adult day care

Integrated Health Care Delivery

• An IHCD system is a network of health care orgs that work together to provide a continuum of health services to a defined population.
• Has intended outcomes of better aligning resources, improving quality, and controlling costs.
• IHCDs were developed with a primary focus on improving health care quality and decreasing overall health care costs.
• The goal of focusing on population health is to decrease health care costs through effective management of patients with chronic health problems.
• Primary and Preventive Health Care Services focus on improving health outcomes for an entire population.
• Includes promoting regular health care visits, health education ,proper nutrition, maternal/child health care, 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 that a primary care physician or nurse practitioner can provide.
• Tertiary health care is specialized consultative care, usually provided on referral from secondary medical personnel.

Hospitals

• Offer comprehensive secondary and tertiary health care to patients who are acutely ill.
• Hospitals vary in the services they offer.
• Most small rural hospitals offer general inpatient services but have limited emergency and diagnostic services.

Intensive Care

• An ICU or critical care unit (CCU) is a hospital unit in which patients receive close monitoring and intensive medical and nursing care.
• The status of a patient who is critically ill can change by the minute, so health care providers must have specialized knowledge and skills.

Mental Health Facilities

• Psychiatric facilities are located in hospitals, independent outpatient clinics, and private mental health hospitals.
• They offer inpatient and outpatient services, depending on the severity of a patient's problem.
• Patients enter mental health facilities voluntarily or involuntarily.

Rural Hospitals

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

Discharge Planning

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

Restorative Care

• Help individuals regain maximal functional status and to enhance quality of life through promotion of independence and self-care.
• For example, some patients require ongoing wound care and activity and exercise management until they recover enough strength and/or function following surgery to independently resume normal activities of daily living

Home Care

• Provision of medically related professional and paraprofessional services and equipment to patients and families in their homes.
• Health maintenance, education, illness prevention, diagnosis and treatment of disease, rehabilitation, and palliative care.
• Focuses on the goal of helping patients and their family members achieve independence.
• Addresses the recovery from 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.
• Gives people with disabilities the tools they need to attain independence and self-determination

Extended Care Facilities

• Provides intermediate medical, nursing, or custodial care for patients recovering from acute illness or those with chronic illnesses or disabilities.
• Includes intermediate care and skilled nursing facilities.
• Some include long-term care and assisted-living facilities.

Continuing Care

• Describes a variety of health, personal, and social services provided over a prolonged period.
• These services are for people who have disabilities, who were never functionally independent, or who have a terminal disease.
• Available within institutional settings such as:
• nursing centers or nursing homes
• group homes
• retirement communities
• Communities like:
  • adult day care and senior centers
• The home:
  • Home care
  • Home-delivered meals
  • Hospice

Issues in Health Care Delivery for Nurses

• Health care agencies improve patient experience and engagement while delivering high-quality care, improving outcomes, and controlling costs
• Health Care Costs and Quality: Cannot separate managing costs and achieving high-quality patient care.
• Nursing Shortage affects aspects of nursing like patient care, administration, and nursing education.
• Represents challenges and opportunities for the profession

Competency

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

Patient-Centered Care

• Care "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.
• Changes the ways in which nurses deliver evidence-based care to patients.
• Technology makes work easier but does not replace clinical judgment and clinical decision making.

Health Care Disparities

• The differences in health care outcomes and dimensions of health care including access, quality, and equity, among population groups.
• Can be related to variables such as race, ethnicity, gender, location, disability, or social determinants.

Philippine Health Care Delivery System

• Includes the Public Sector and Private Sector

Public Sector

• Is financed by the government and where health care is generally given free at the point of service.

Private Sector

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

Philippine Health Care Delivery System Public Sector

• Executive Order 102 identifies DOH as the national authority on health providing technical and other resource assistance to concerned groups.
• Mandates that the DOH performs the roles related to leadership in health, enabler and capacity builder and administrator of specific services

RA 7160 (Local Government Code)

• Transfers the responsibility for the delivery of basic services and facilities to local governments.
• Includes health services.
• Aims to making them self-reliant and active partners in the attainment of local goals through more responsive and local government structure.

Explore the core principles of Integrated Health Care Delivery (IHCD) systems, emphasizing their primary focus and goals, particularly in population health. Learn about different levels of health care, specialist referrals, and the characteristics of various health care settings like ICUs. Assess the goals of agencies balancing patient experience with financial aspects.