Patient Care Settings & Planning

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

Examples of Health Care Services

• 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 (seat belts, car seats for children, 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
  • Hospital emergency care
  • Acute medical-surgical care
  • Ambulatory care
  • Outpatient surgery
  • Hospital care
  • Radiological procedures
• Tertiary care includes:
  • Highly specialized care
  • Intensive care
  • Inpatient psychiatric facilities
  • Specialty care like neurology, cardiology, rheumatology, dermatology, oncology
• Restorative care includes:
  • Rehabilitation programs like cardiovascular, pulmonary, orthopedic
  • Sports medicine
  • Spinal cord injury programs
  • Home care
• Continuing care includes:
  • Long-term care like assisted living, nursing centers
  • Psychiatric and older-adult day care

Integrated Health Care Delivery (IHCD)

• An IHCD system is a network of health care organizations that work together and provide a continuum of health services to a defined population.
• Outcomes include 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.

Levels of Health Care Services

• Primary and preventive health care focuses on improved health outcomes for an entire population.
• Primary and preventive health care promotes:
  • Regular health care visits
  • Health education
  • Proper nutrition
  • Maternal/child health care
  • Family planning
  • Immunizations
  • Control of diseases
• Secondary health care is provided by a specialist or agency on referral by a primary health care provider.
• Secondary health care requires more specialized knowledge, skill, or equipment than the primary care physician or nurse practitioner can provide.
• Tertiary health care is specialized consultative care, usually provided on referral from secondary medical personnel.
• Hospitals provide 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.
• An ICU (Intensive Care Unit) or CCU (Critical Care Unit) is a hospital unit where patients receive close monitoring and intensive medical and nursing care.
• The status of a patient who is critically ill can change by the minute requiring health care providers with specialized knowledge and skills.
• Psychiatric facilities exist in hospitals, independent outpatient clinics, and private mental health hospitals.
• Mental health facilities offer both inpatient and outpatient services depending on the severity of the patient's problem. Patients may enter mental health facilities voluntarily or involuntarily.
• Lack of access to health care in rural areas is a serious public health problem.
• Discharge planning is a coordinated, interprofessional process which 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 like home, rehabilitation, or long-term care.
• Restorative care helps individuals regain maximal functional status and to enhance quality of life through promotion of independence and self-care.
• Some patients require ongoing wound care, activity, and exercise management following surgery to independently resume normal activities of daily living.
• Home care is the provision of medically related professional and paraprofessional services and equipment to patients and families in their homes.
• Home care covers health maintenance, education, illness prevention, diagnosis and treatment of disease, rehabilitation, and palliative care.
• Home health care focuses on helping patients and their family members achieve independence addressing the recovery from, and stabilization of, an illness.
• 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.
• Rehabilitation gives people with disabilities the tools they need to attain independence and self-determination
• An extended care facility provides intermediate medical, nursing, or custodial care for patients recovering from acute illness or those with chronic illnesses or disabilities.
• Extended care facilities include intermediate care and skilled nursing facilities
• Some include long-term care and assisted-living facilities.
• Continuing care encompasses a variety of health, personal, and social services that continue over a long period for people with disabilities, those who had never been functionally independent, or those with a terminal disease.
• Continuing care is available within institutional settings (e.g., nursing centers or nursing homes, group homes, and retirement communities), communities (e.g., adult day care and senior centers), or the home (e.g., home care, home-delivered meals, and hospice)

Issues Health Care Delivery for Nurses

• Health care agencies today are working hard to improve patient experience and engagement while delivering high-quality care, improving outcomes, and controlling costs.
• Managing costs and achieving high-quality patient care are inseparable initiatives facing health care institutions.
• The nursing shortage affects all aspects of nursing including patient care, administration, and nursing education, it also represents challenges and opportunities for the profession.
• Competency is demonstrated through The Quality and Safety Education for Nurses (QSEN) project, which developed quality and safety competencies for nurses.
• The QSEN competencies provides nurses with the knowledge, skills and attitudes to meet the challenges in today's health care settings.
• Patient-centered care is care that is respectful of and responsive to individual patient preferences, needs, and values. Patient values guide all clinical decisions
• Technological advances continually affect health care organizations and change the ways in which nurses deliver evidence-based care to patients.
• Technology makes work easier but does not replace clinical judgment and decision making.
• Disparities in health care are differences in health care outcomes and dimensions of health care (including access, quality, and equity) among population groups.
• Disparities can be related to variables like race, ethnicity, gender, location, disability, social determinants

Philippine Health Care Delivery System

• The Philippine Health Care Delivery System is composed of two sectors: public and private.
• The Public Sector is financed by the government and health care is generally given free.
• The Private Sector is owned, controlled and managed by individuals, groups or business entities where health care is paid through user fees
• Executive Order 102 identifies DOH as the national authority on health providing technical and other resource assistance to concerned groups.
• Executive Order 102 mandates DOH to perform the roles related to leadership in health, enabler and capacity builder and administrator of specific services
• RA 7160 (Local Government Code ) transfers to the local government the responsibility for the delivery of basic services and facilities making them self reliant and active partners in the attainment of local goals

Questions about healthcare settings, transition planning, wound care, and stroke rehabilitation. Review these topics to improve patient outcomes and quality of life. Designed to evaluate understanding of patient care.