Stanfield's Intro to Health Professions (PDF)

Stanfield’s HEALTH INTRODUCTION TO PROFESSIONS Seventh Edition Nanna Cross, PhD, RDN, LDN Cross & Associates Chicago, Illinois Dana C. McWay, JD, RHIA, FAHIMA Saint Louis University...

Stanfield’s HEALTH INTRODUCTION TO PROFESSIONS Seventh Edition Nanna Cross, PhD, RDN, LDN Cross & Associates Chicago, Illinois Dana C. McWay, JD, RHIA, FAHIMA Saint Louis University St. Louis, Missouri   World Headquarters Jones & Bartlett Learning 5 Wall Street Burlington, MA 01803 978-443-5000 [email protected] www.jblearning.com Jones & Bartlett Learning books and products are available through most bookstores and online booksellers. To contact Jones & Bartlett Learning directly, call 800-832-0034, fax 978-443-8000, or visit our website, www.jblearning.com. Substantial discounts on bulk quantities of Jones & Bartlett Learning publications are available to corporations, professional associations, and other qualified organizations. For details and specific discount information, contact the special sales department at Jones & Bartlett Learning via the above contact information or send an email to [email protected]. 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If legal advice or other expert assistance is required, the service of a competent professional person should be sought. 10316-8 Production Credits VP, Executive Publisher: David D. Cella Rights & Media Specialist: Jamey O’Quinn Publisher: Cathy L. Esperti Media Development Editor: Troy Liston Associate Director of Production: Jenny L. Corriveau Cover Images: Nurse with Tablet: © iStockphoto/Getty Images; Dentist: © foto infot/ Associate Production Editor: Alex Schab Shutterstock/; Vet: © DuxX/Shutterstock/; Lab: © iStockphoto/Getty Images; Surgeons: Marketing Manager: Grace Richards © xmee/Shutterstock; Figure: © Sebastian Kaulitzki/Shutterstock VP, Manufacturing and Inventory Control: Therese Connell Printing and Binding: RR Donnelley Composition: Cenveo Publisher Services Cover Printing: RR Donnelley Cover Design: Kristin E. Parker Library of Congress Cataloging-in-Publication Data Names: Cross, Nanna, author. | McWay, Dana C., author. | Preceded by (work): Stanfield, Peggy. Introduction to the health professions. Title: Stanfield’s introduction to health professions / Nanna Cross, Dana C. McWay. Other titles: Introduction to health professions Description: Seventh edition. | Burlington, Massachusetts : Jones & Bartlett Learning, | Preceded by Introduction to the health professions / Peggy S. Stanfield, Nanna Cross, Y.H. Hui. 6th ed. c2012. | Includes bibliographical references and index. Identifiers: LCCN 2016017102 | ISBN 9781284098808 Subjects: | MESH: Health Occupations | Allied Health Personnel | Vocational Guidance | Career Choice | United States Classification: LCC R690 | NLM W 21 | DDC 610.69–dc23 LC record available at https://lccn.loc.gov/2016017102 6048 Printed in the United States of America 20 19 18 17 16 10 9 8 7 6 5 4 3 2 1 The Seventh Edition of Stanfield’s Introduction to Health Professions is dedicated to the authors of previous editions, Y.H. Hui and Peggy S. Stanfield, and to all students and practitioners in the health professions. -Nanna Cross To my husband Patrick for his support in the development of this textbook. -Dana C. McWay  CONTENTS Note from the Authors...................... vii Chapter Four Aging, Health, and Preface................................... viii Long-Term Care................ 37 About the Authors........................... ix The Impact of Future Demographic Changes Reviewers................................. xii on Healthcare Needs...................... 38 Common Health Problems in an Aging PART ONE THE HEALTHCARE SYSTEM IN Population............................... 38 THE UNITED STATES................ 1 Medicare for Older Adults................... 39 Medicaid for Older Adults................... 40 Long-Term Services and Support (LTSs)....... 40 Chapter One U.S. Health Care......... 3 Community Long-Term Services.............. 41 Introduction................................ 4 Other Community Programs for Older Adults Historical Events Impacting Health Care........ 4 and Disabled Persons...................... 44 A Look Back................................ 4 Demographic Trends and Projections.......... 44 A Look Forward............................. 5 Personnel Needs............................ 46 Impact of Technology on Healthcare Services.... 7 Summary.................................. 47 Trends that Will Impact Health Services and Health Careers............................ 8 Chapter Five Health Care Reform...... 51 Summary................................... 8 Overview of Healthcare Reform.............. 52 Timeline for Implementing the ACA.......... 53 Chapter Two Categories of Health Challenges to Launching the Affordable Services...................... 11 Care Act................................ 55 Overview of the U.S. Healthcare System....... 12 Supreme Court Decisions and Changes to Categories of Healthcare Services............. 12 the ACA................................ 55 Healthcare Facilities......................... 13 Access to Health Care Varies by State.......... 57 Hospitals: Development and Services.......... 14 The Impact of the ACA on Healthcare Cost.... 57 Ambulatory Healthcare Services.............. 17 Summary.................................. 59 Mental Health Services...................... 17 The Consumer’s Rights...................... 18 Chapter Six Medical and Health Public Health Services....................... 18 Information Technology.......... 63 Health Care in The Twenty-First Century...... 22 Introduction............................... 64 Chapter Three Paying for Health Medical Technology......................... 64 Services...................... 25 Health Information Technology.............. 67 Summary.................................. 71 Healthcare Financing  ....................... 26 Reimbursement for Healthcare Services........ 26 Government-Funded Health Insurance........ 27 PART TWO JOBS AND CAREERS...... 73 History of Health Insurance in the United States... 29 Managed Care: HMOs, PPOs, and EPOs....... 30 Chapter Seven Health Career Planning. 75 Private Health Insurance Coverage in Introduction............................... 76 the United States.......................... 31 Who Are the Healthcare Workers?............ 76 Healthcare Expenditures..................... 31 Projected Demand for Healthcare Personnel.... 77 iv Effect on Healthcare Providers................ 33 Employers of Health Professionals............ 78  Contents v Exploring Health Careers.................... 82 Chapter Fifteen Optometry......... 173 Health Careers: Something for Everyone....... 84 Optometrists.............................. 174 Using This Book to Select and Plan a Health Optician, Dispensing....................... 177 Career................................... 85 Ophthalmic Laboratory Technicians......... 180 Additional Information...................... 85 Study Points............................... 87 Chapter Sixteen Communication Impairment Professionals........ 183 Chapter Eight Career Development.... 89 Speech, Language, and Hearing Impairments: Introduction............................... 90 An Overview............................ 184 Career Development........................ 90 Speech-Language Pathologists............... 185 Common Core Knowledge................... 90 Audiologists.............................. 188 Professionalism............................. 92 Additional Information..................... 193 Legal Issues in Health Care................... 95 Continuing Education Requirements.......... 97 Chapter Seventeen Physical Therapy, Summary.................................. 97 Orthotists, and Prosthetists....... 195 Physical Therapy and Our Health............ 196 Physical Therapists......................... 196 PART THREE HEALTH PRACTITIONERS Physical Therapist Assistants and Aides....... 200 AND TECHNICIANS............... 99 Orthotists and Prosthetists.................. 203 Chapter Nine Physicians, Surgeons, and Podiatrists................ 101 Chapter Eighteen Occupational Therapy..................... 207 Physicians and Surgeons: The Perceptions..... 102 Doctors and Surgeons: The Realities.......... 102 Occupational Therapists.................... 208 Podiatrists................................ 108 Occupational Therapy Assistants and Aides... 213 Additional Information..................... 117 Chapter Nineteen Athletic Trainers and Chapter Ten Physician Assistant...... 113 Exercise Physiologists........... 217 A Relatively New Profession................. 114 Sports Medicine—An Introduction.......... 218 Physician Assistant......................... 114 Athletic Trainers........................... 218 Exercise Physiologists...................... 223 Additional Information..................... 225 Chapter Eleven Nursing............ 119 The Future of Nursing...................... 120 Chapter Twenty Mental Health Registered Nurses (RNs).................... 121 Professionals................. 227 Advanced Practice Registered Nurses (APRNs). 126 Introduction.............................. 228 Licensed Practical and Licensed Psychologists.............................. 228 Vocational Nurses........................ 132 Substance Abuse and Behavioral Disorder Counselors.............................. 233 Chapter Twelve Dentistry........... 137 Dentists.................................. 138 Chapter Twenty One Social Workers.. 239 Dental Hygienists.......................... 141 Introduction.............................. 240 Dental Assistants.......................... 144 Social Workers............................ 240 Dental Laboratory Technicians.............. 147 Social and Human Service Assistants......... 245 Additional Information..................... 248 Chapter Thirteen Dietetics.......... 151 Dietitians and Nutritionists................. 152 Chapter Twenty Two Genetic Dietetic Technicians........................ 157 Counselors................. 251 Dietetic Assistants......................... 160 Genetic Counselors........................ 252 Additional Information..................... 160 Chapter Twenty Three Health Chapter Fourteen Pharmacy........ 163 Education.................... 257 Pharmaceutical Partners.................... 164 Health Careers Specializing in Education..... 258 Pharmacists............................... 164 Health Educators.......................... 258 Pharmacy Technicians and Aides............ 168 School Health Educators.................... 261 vi Contents Community Health Workers................ 262 Chapter Thirty One Health Orientation and Mobility Specialists.......... 264 Information Personnel.......... 347 Vision Rehabilitation Therapists............. 266 Providing and Preserving Essential Behavior Analysts—An Overview............ 269 Information............................ 348 Additional Information..................... 270 Health Information Management............ 348 Health Information Administrators.......... 349 Chapter Twenty Four Health Services Health Information Technicians............. 354 Administration................ 273 Medical Transcriptionists................... 356 Administration............................ 274 Medical Librarians......................... 359 The Need for Professional Management....... 274 Health Services Managers................... 274 Chapter Thirty Two Medical and Nursing Assistants.......... 363 Chapter Twenty Five Emergency Medical Technicians Medical Assistants......................... 364 and Paramedics............... 281 Nursing Assistants and Orderlies............ 368 High Drama in Health Care................. 282 EMT-Paramedics.......................... 282 Chapter Thirty Three Home, Personal, and Psychiatric Chapter Twenty Six Radiation Aides....................... 373 Technology................... 287 Home Health Aides........................ 374 X-Rays and Beyond........................ 288 Personal Care Aides........................ 377 Radiologic Technologists and Technicians..... 288 Psychiatric Technicians and Aides............ 379 Radiation Therapists....................... 291 Chapter Twenty Seven Diagnostics PART FIVE HEALTH-RELATED and Related Technology......... 297 PROFESSIONS.................. 383 Introduction.............................. 298 Diagnostic Medical Sonographers............ 298 Chapter Thirty Four Veterinary Cardiovascular Technologists and Technicians... 302 Medicine................... 385 Nuclear Medicine Technologists............. 305 Working with Animals..................... 386 Surgical Technologists...................... 308 Veterinary Medicine....................... 386 Veterinarians.............................. 387 Chapter Twenty Eight Respiratory Veterinary Technologists and Technicians..... 390 Care Practitioners.............. 313 Animal Care and Service Workers............ 393 Maintaining the Breath of Life............... 314 Additional Information..................... 396 Respiratory Therapists...................... 314 Respiratory Therapy Technicians............ 318 Chapter Thirty Five Occupational Health and Environmental PART FOUR HEALTHCARE SUPPORT Science...................... 399 PERSONNEL................... 321 Protecting the Worker—Protecting the Environment............................ 400 Chapter Twenty Nine Clinical Occupational Health and Safety Specialists.... 400 Laboratory Personnel........... 323 Occupational Health and Safety Technicians... 402 Environmental Scientists and Specialists...... 405 The Laboratory Team...................... 324 Environmental Science and Protection Clinical Laboratory Scientists and Technicians.... 324 Technicians............................. 408 Phlebotomists............................. 329 Additional Information..................... 410 Additional Information..................... 330 Appendix A: Salaries for Health Professionals.. 413 Chapter Thirty Massage Therapists and Recreational therapists...... 333 Appendix B: Sources of Career Information... 416 Alternative and Other Therapies............. 334 Appendix C: How to Create an Effective Massage Therapists........................ 343 Résumé................................ 420 Recreational Therapists..................... 337 Glossary.................................. 425 Additional Information..................... 343 Index.................................... 451 NOTE FROM THE AUTHORS Careers in the healthcare field are growing more rapidly and physical therapy, and an associate’s degree for support than other careers because of longevity and advanced tech- personnel in the same field. Physical therapy and occupa- nology that has increased the number of elderly needing tional therapy assistants trained at the associate’s level are health care. Within health care there is a career for nearly being used to support the work of professionals because of everyone—from entry-level positions as a home health aide the lower cost for their services. that require no prior training to being employed as a physi- Information technology is changing the way health care cian that requires 7 to 8 years of college plus an internship to is delivered as well as the way consumers manage their health. enter a career. Electronic health records that are accessible by professionals This text is designed so that the instructor can select indi- regardless of physical location are cost effective and improve vidual chapters for a course. Most college texts are organized the quality and safety of health care. Many patients now have to be followed from the beginning of the book through the access to lab values and other text results through a patient last chapter. By contrast, instructors using this text can select portal within the electronic health record. Technology also only certain chapters based on the course objectives since each makes it possible for patients to do more self-monitoring chapter is written to be understandable and comprehensive as and to communicate results back to their physician, nurse, or a standalone. Key terms unique to health care are defined in the caseworker. For example, blood glucose and blood pressure glossary at the end of the text and are listed at the beginning of can be monitored by the patient and the results transmitted each chapter so students can refer to the glossary as needed. to the health care provider. WHAT ARE THE LATEST TRENDS Nanna Cross, PhD, RDN, LDN Dana C. McWay, JD, RHIA, FAHIMA IN THIS MARKET? The trend is to require a master’s degree or above for entry-level professional degrees such as occupational therapy vii  PREFACE Now in full-color, the seventh edition of an Introduction to explore many different health careers. Each chapter Health Professions provides comprehensive coverage of all follows the same format with a description of the the major health professions. This product is designed for profession and typical work setting; educational, students who are interested in pursuing a health-related licensure and certification requirements; salary and career but are still exploring and have not yet decided on a growth projections; and Internet resources on ed- specific career. The Seventh Edition outlines more than 75 ucational programs and requirements for licensure careers and touches on every major facet of the field, in- and/or certification. For example, in the chapter cluding a description of the profession and typical work set- on dentistry, the career is described based on the tings; educational, licensure, and certification requirements; education and training requirements from most salary and growth projections; and Internet resources on education—dentist—to least education—dental educational programs and state requirements for licensure assistant. For each career within the dentistry pro- and/or certification. In addition, this resource provides a fession, the student has access to the usual respon- thorough review of the U.S. healthcare delivery system, sibilities, work setting, salary, and expected demand managed care, healthcare financing, reimbursement, insur- for that career. Each chapter lists Internet resources ance coverage, Medicare, Medicaid, and the impact of new to explore educational programs as well as state technology on healthcare services. Information on career requirements for licensure and certification options preparation and development are also included. All chapters for advancing in the profession. are updated to reflect current demographics and new policies. Part III—Healthcare Practitioners and Tech- nicians. This section is the core of the prod- uct and contains 20 chapters directed at health HOW IS THIS BOOK careers that involve direct patient contact and ORGANIZED? care, ranging from diagnosis to treatment The new edition of this text has been reorganized into five to education and counseling and medical or sections surgical interventions. Part IV—Healthcare Support Personnel. This Part I—The Healthcare System in the United section contains five chapters directed at health States. This section provides an overview of the careers that support or supplement other healthcare system in the United States, with sep- health professionals in providing ongoing care arate chapters on categories of health services, for patients—medical and nursing assistants, financing health care, the impact of aging on de- personal, home, and psychiatric aides; medi- mands for healthcare providers, health care reform, cal information technology; and massage and and medical and information technology. recreation therapy. NEW! Part II—Jobs and Careers. This section fo- Part V—Health-Related Professions. This cuses on career planning and career development. section focuses on health-related profession- NEW! Parts III through V contain chapters on in- als who usually do not have direct contact dividual careers that are organized so that students with human patients but often have an im- will be able to quickly identify a particular career pact on human health—veterinary medicine of interest. Each chapter is organized to follow the and occupational health and environmental same general format, making it easy for students to sciences. viii ABOUT THE AUTHORS Nanna Cross, PhD, RDN, LDN has worked as a faculty Health Informatics and Pre Law Studies programs. She serves member in dietetic and physician education programs as the Clerk of Court for the U.S. Bankruptcy Court for the teaching clinical nutrition courses and supervising dietetic Eastern District of Missouri, an executive position responsible interns in clinical practicums. Dr. Cross worked as a clinical for all operational, administrative, financial, and technological dietitian at the University of Missouri Hospitals and Clinics matters of the court. She has worked as both a director and as- and as a consulting dietitian for Home Care, Hospice, Head sistant director of medical records in a large teaching hospital Start and Long-Term Care facilities. and a for-profit psychiatric and substance abuse facility. She is a past Director on the Board of Directors of the American Dana C. McWay, JD, RHIA, FAHIMA is both a lawyer and Health Information Management Association and serves as a a health information management professional. She works as voting member of the Institutional Review Board at Washing- an adjunct faculty member at Saint Louis University in the ton University School of Medicine, from 1992 to present. Special Thank you to our Ancillary Authors: Gaynelle Schmieder RN, NCMA, BSN, M.ED. Assistant Professor and Lead Faculty/Health Care Professions Program Director/Medical Assisting Technology ACE Faculty Liaison Pennsylvania Highlands Community College Johnstown, PA Tammy Calpin MSN, RN, CSN, NCMA Instructor, Medical Assisting/Practicum Coordinator Pennsylvania Highlands Community College Johnstown, PA ix  NEW FEATURES 91 Professional Profiles Name: Amanda, RN, ADN Job Title: Charge Nurse Education: Associates in Nursing; enrolled for BSN Q: Tell us about your career progression. Q: Without disclosing protected health A: After graduating from nursing school, I hired information, describe an ethical challenge on at a local hospital with 113 beds and soon after you’ve faced and how have you found myself a charge nurse on a 31-bed high acu- addressed it. ity telemetry unit. Diagnoses of our patients varied A: As a nurse I often am witness to ethical dilemmas from congestive heart failure, myocardial infarction, within the acute care setting. When taking care of an cardiomyopathy, and many chest pain rule outs that elderly patient who had decided to go on hospice, resulted in other various outcomes. I witnessed many family members who came in to I recently took a position on a 40-bed medical floor visit who were not in agreement with the patient’s as a free charge nurse. My job now allows me to fo- decision. Over the course of a few days the patient cus on the hospital’s quality indicators and outcomes. Interviews with Professionals had become very weak and unable to communicate. I get to round on patients in the morning to deter- Many family members began to demand that the mine the needs of my colleagues and the floor. I love decision to start hospice care be reversed and that the role I am currently in because I can advocate for [hospital staff] resume treatment for the patient’s patients by discussing the care they are receiving and cancer. When involved in caring for large families learning ways to improve our delivery. and patients with terminal illness, it is important to Including Frequently Asked Question/Answer section. advocate for the patient. At times, it can be emo- Q: What challenges you about your tionally taxing, and your own beliefs may not agree profession? with those of the patient; however, it’s important to A: Nursing has been a very challenging yet fulfilling keep your own beliefs out of it. Ultimately, in this career for me. It has allowed me to develop a profes- particular situation, my patient had paperwork that sional skill set, build relationships with patients, and reflected his wants and needs for end-of-life care. He learn on a daily basis from my peers. I have recently had made a decision to die peacefully, and my job become engaged in community events while sitting was to allow him just that. We called a chaplain in to on the Young Professional Advisory Board in my comfort the family and help them understand that county. I have had many great opportunities while the patient was clear about his wishes. In this case, working as a registered nurse and look forward to the family just needed support to accept his wishes. many to come. Death is hard for all parties involved, but as a nurse, my first priority was advocacy for my patient. Q: How have you demonstrated professionalism in your career? Q: Describe the continuing education requirements for your profession. A: Over the years, my career has presented me with many opportunities to grow as a professional. The A: Continuing education is mandated each year and hospital has a clinical development program that al- can be different from unit to unit. My floor must par- lows nurses to put together a portfolio representing ticipate in a skills lab that ensures that we are profi- their work over time. There are many requirements cient in a number of clinical skills. We must also ob- including service in the community, continuing edu- tain eight hours of continuing education hours that cation, awards or recognition from patients, and par- we can do online or take classes within the hospital. ticipation in committees or improvement events that Throughout the hospital, there are multiple types of take place in the hospital. Developing this portfolio equipment to safely transfer patients who need as- and committing to the work that it entails encour- sistance with ambulation, so every year we have to ages me to view my job as a nurse as something much demonstrate proficiency in safe patient handling. It more. Nursing is a profession and has been elevated is also mandatory to keep up to date a BLS [basic life to that over time. As a nurse, I feel it’s my obligation support] card and in some areas ACLS [advanced car- to continue to engage myself into my community diac life support]. and help represent what the profession of nursing is. 98 CHAPTER 8 Career Development LEARNING PORTFOLIO Study Points Enrichment Activities 1. Career development stretches beyond what is needed 1. Safety of healthcare professionals is an important initially to enter into a healthcare profession. function of the job. Research the Internet for the rates 2. Training for healthcare students includes similarities of injury to registered nurses, physicians, nurse’s aides, across disciplines, referred to as a common core of dietitians, physical therapists, respiratory therapists, knowledge. and housekeeping staff. Create a chart comparing the types and rates of injury among these healthcare pro- 3. Healthcare professionals who act in an accountable fessionals. and ethical manner in the workplace and maintain a steady composure in the face of adversity demonstrate 2. Codes of ethics exist in virtually every healthcare professionalism. profession. Research the websites of any of the pro- fessional associations listed in subsequent chapters to 4. Codes of ethics are common across virtually every Learning Portfolio see what they include in their code of ethics. Create a healthcare discipline. chart identifying the similarities and differences be- 5. Healthcare professionals who breach confidentiality tween the codes of ethics of various professional as- not only damage their relationship with the patient, sociations. they may also violate the law and professional require- 3. Continuing education is usually a central tenet of a ments. At the end of each chapter, this review section includes: Study professional association. Research the websites of any 6. Many healthcare practitioners contribute to the suc- of the professional associations listed in subsequent cessful treatment of patients through health teams. chapters to see what types and how much continuing 7. Malpractice is professional misconduct. education activity is required over a specified period 8. Continuing education is an integral part of career de- velopment. of time. Create a chart comparing this information for each profession chosen. Points, Issues for Discussion, and Enrichment Activities. Issues for Discussion References 1. At one time or another, most everyone has encoun- All sections are thoroughly updated to reflect current training 1. Material related to the common core of knowledge arises tered someone who has acted in a less-than-profes- from two sources: The National Health Science Stan- sional manner. Discuss with your instructor and dards, National Consortium for Health Science Education classmates examples you have experienced of this (2015) available at: http://www.healthscienceconsortium. phenomenon. Describe what actions you think requirements, responsibilities, and salaries, as established in org/wp-content/uploads/2015/07/NATIONAL-HEALTH- should have been taken in these examples that could SCIENCE-STANDARDS-May-2015f1-PE2.pdf and Health have turned the non-professional situation into a pro- Science Alignment – Common Core Mathematics, Depart- the Occupational Outlook Handbook 2016-2017 Edition. fessional situation. ment of Elementary and Secondary Education, State of Mis- souri (2011) available at: http://dese.mo.gov/sites/default/ 2. Math anxiety has played a role in discouraging per- files/HealthSciMath.pdf. sons from pursuing entry into the health professions. 2. Tarasoff v. Regents of University of California, 529 P.2d 553 Brainstorm with your classmates and instructor the (Cal. 1974), reargued, 551 P.2d 334 (Cal. 1976). reasons math anxiety exists, considering whether 3. Corn v. French, 289 P.2d 173 (Nev. 1955). timed tests and the risk of public embarrassment play a role. Discuss what actions can be taken to lessen or 4. Katsetos v. Nolan, 368 A.3d 172 (Conn. 1976). eliminate math anxiety. x New Careers The Teaching Package for Includes nine new careers! the Instructor Podiatrist (Chapter 9) Teacher resources include the Learning Portfolios at the end Orthotics and Prosthetics (Chapter 17) of each chapter, which are designed to be used by both the Exercise Physiologist (Chapter 19) student and instructor. In addition, the following items are Substance Abuse and Behavioral Disorders part of the Instructor’s Teaching Package: Counselor (Chapter 20) Test Bank for each chapter Genetic Counselor (Chapter 22) PowerPoint slides for each chapter Community Health Worker (Chapter 23) Instructor’s Manual with the following components: Board-Certified Behavior Analyst (Chapter 23) –– Chapter Overview Phlebotomist (Chapter 29) –– Lesson Objectives Massage Therapist (Chapter 30) –– Resources –– Suggested Lecture Outline –– Discussion Questions THE LEARNING AND –– Suggested Learning Activities TEACHING PACKAGE –– Homework The Learning Package for Bloom’s Taxonomy the Student The Learning Package for the student and the Teaching Students can review the Learning Portfolios at the end Package for the instructor are designed to incorporate of each chapter. For the first eight chapters of the text, the Bloom’s levels of learning from the lowest level of knowl- Learning Portfolio includes Study Points, a brief summary edge to the highest level of evaluation. The learning and of the chapter content. All chapters also include Issues for teaching packages that accompany the text encourage go- Discussion and Enrichment Activities designed to be used by ing beyond the content of the text. The text is expected to the student for self-study and exploration. be a starting point. New Features xi  REVIEWERS Karen Bakuzonis, PhD, MSHA, RHIA Darlene Martin, MEd, ATC Chair Health Informatics Department Liberty University Ashford University Kristen L. McHenry, MS, RRT-ACCS William Ballard, MA, MEd Director of Cardiopulmonary Science Program Assistants Academic Advisor College of Business Professor – Department of Allied Health Sciences Florida Atlantic University College of Clinical and Rehabilitative Health Sciences East Tennessee State University Dr. Barry Brock Academic Coordinator/Health Services Administration Barry University School of PACE Jahangir Moini, MD, MPH Professor of Science and Health Dr. Kenneth L. Campbell, MPH, MBA, MA Eastern Florida State College Adjunct Professor Department of Health Sciences at Chicago State University Cindy Mulder, MSN Adjunct Professor and Interim Community Health Worker Instructor (CHW) Program Director at City Colleges of Chicago University of South Dakota Cook County System Operations Analyst Cook County Health and Hospitals System (CCHHS) and Cook County Department of Public Health (CCDPH) Amy Nelson, MS OTR/L, MT(ASCP) University of South Dakota Karen Collins Gibson, MSA, RHIA, FAHIMA Delaware County Community College Dr. Dennis Palkon, PhD, MPH, MSW Professor and Director of Management Programs/Health Nicole L. Hatcher, PH.Sc, MPAS, PA-C Administration/Business Assistant Professor Florida Atlantic University Howard University Andrea Koepke, PhD, RN Bonita Sasnett, EdD Dean – College of Health Professions East Carolina University The University of Findlay Barbara Marchelletta, CMA (AAMA), CPC, RHIT, CPT Erin Sayer, PhD Program Director – Allied Health Chief Academic Advisor – School of Biological Sciences Beal College University of Nebraska – Lincoln xii Figure: © Shutterstock/Sebastian Kaulitzki  PART ONE The Healthcare System in the United States Nurse with tablet: Getty Images/iStockphoto; OR: Shutterstock/xmee; Dog: Shutterstock/DuxX; Man in lab: Getty Images/iStockphoto; Dentist: Shutterstock/foto infot; Spine: Shutterstock/Sebastian Kaulitzki Figure: © Shutterstock/Sebastian Kaulitzki © stefanolunardi/Shutterstock CHAPTER 1 U.S. Health Care Objectives After studying this chapter, the student should be able to: Discuss the changes in health problems of the population in the United States over the past 150 years. Identify expected future changes in the health of the population that will influence healthcare needs and career opportunities in health care. Explain the role of the government in the expansion of health care. Key Terms Acute infectious diseases Ebola virus Life expectancy Affordable Care Act (ACA) Electronic health records (EHRs) Lifestyle Applied behavior analysis (ABA) Epidemics Longevity Autism spectrum disorder (ASD) Globalization Medicaid Avian influenza Health Exchange Medical technology Centers for Disease Control and Health information technology Methicillin-resistant Prevention (CDC) (health IT) Staphylococcus aureus (MRSA) Chronic illness Health outcomes National Prevention Council Children’s Health Insurance Human Genome Project Sepsis Program (CHIP) Infant mortality World Health Organization (WHO) Clinical preventive services Infectious disease 3 4 CHAPTER 1 U.S. Health Care Introduction This Seventh Edition differs from the first six editions for two reasons. First, three new chapters have been added: Chapter 6: Medical and Health Information Technology, Chapter 8: Career Development, and Chapter 22: Genetic Counseling. Second, discussion questions and enrichment activities have been added to each chapter. The impact of healthcare reform legislation on healthcare delivery systems and careers has been incorporated into this edition. HISTORICAL EVENTS The United States will need to continue to improve the efficiency and quality of health care and reduce disparities in IMPACTING HEALTH CARE access to health care for all Americans. With that premise, we Controlling healthcare costs and increasing access to health begin this chapter with a look back at healthcare issues and care were policy priorities for President Barack Obama treatments developed in the past 150 years. Much of the ma- with the passage of the Affordable Care Act (ACA) signed terial from the sixth edition of this text is still relevant. The suc- into law on March 23, 2010.1 Some of the reasons for the ceeding chapters have been updated to reflect the anticipated rising costs of health care are the use of expensive medical changes and demographics of the 21st century, and the chang- technology and prescription drugs, reimbursement sys- ing nature of health care and opportunities for health careers. tems that reward the volume of medical services instead of outcomes, inadequate preventive services, the aging of the population, and the increased prevalence of chronic dis- A LOOK BACK ease, as well as high administrative costs.2 Healthcare costs Since the dawn of recorded history (and undoubtedly be- have been a concern of the government because growth fore), human beings have suffered sudden and devastating in healthcare costs exceeded growth of the United States epidemics and diseases. In the United States in the second economy beginning in the 1970s and 1980s at a high of 10% half of the 19th century, the most critical health problems to 12% with a drop between 2010 and 2012, when health- were related to contaminated food and water and inadequate care spending was comparable to growth of the economy at housing, and sewage disposal. A countrywide cholera epi- 3%.3 Another critical issue that needs to be addressed is the demic and a yellow fever epidemic killed more than 30,000 inefficiencies and disparities in the current system. Com- people between 1853 and 1858. parisons with other countries and across states show large By 1900, infectious disease epidemics had been brought variations in spending without commensurate differences under control as a result of improving environmental con- in health outcomes.4 ditions. Cities developed systems for safeguarding the milk, The most significant change in health care in the United food, and water supply, and health departments began to grow, States in the past five years is the number of individuals who applying case findings and quarantines with good results. The have access to health care with the implementation of the major epidemics that had caused deaths had been eliminated ACA. At the end of 2014, 15.6 million people had health in- in the United States, and the pendulum swung away from surance through either a private health insurance carrier or acute infectious diseases and toward chronic conditions. a Health Exchange. Total enrollment through a Health Ex- Pneumonia, tuberculosis, diarrhea, and diphtheria ac- change totaled 6.7 million in 2014 and 11.7 million in 2015.5 counted for one-third of all deaths in the 1900s. The most im- Also, between the summer of 2013 and January 2015, there portant factor in the decline in mortality in the 20th century was a 19% increase in the number enrolled in either Med- was essential hygiene, supported by home and workplace icaid or the Children’s Health Insurance Program (CHIP) improvements and attempts to improve the environment. for a total of 11 million additional low-income children and Better hygiene accounted for approximately one-fifth of the adults with access to health care.6 Even with greater access reduction in mortality.8 to health insurance—an estimated 30 million people con- Another reason for the falling death rate was the improve- tinue to be uninsured—the majority of the uninsured are ment of nutrition, which led to an increase in the resistance low income with poor health who live in states that opted to diseases. Once sanitation improved, lack of food and the out of Medicaid expansion under the ACA.7 Greater access resulting malnutrition were largely responsible for infectious to health care increased demand for providers (physicians, diseases. Nutritional status is a critical factor in a person’s re- nurses and other healthcare workers), hospitals, outpatient sponse to infectious diseases, especially young children. Ac- clinics and home-care services. The healthcare environment cording to the World Health Organization (WHO), the best has become more competitive, in large part because of the re- “vaccine” against common diseases is an adequate diet. quirements for hospitals to improve both the quality of care With epidemics behind them, the scientific community and efficiency as a result of the ACA. began working on better surgical techniques, new treatment  A Look Forward 5 The introduction of antiviral therapy in the 1990s re- duced the death rate from the human immunodeficiency virus (HIV) by 80%.10 The effectiveness of new treatments, including drug therapy, increased life expectancy over a 30-year period be- tween 1980 and 2013; life expectancy increased from 70 to 76.4 years in men and from 77.4 to 81.2 years in women (FIGURE 1.3). Infant mortality rates fell to a historically low level of 5.96 per 1,000 births, a 13% decline between 2003 and 2013.9 Longevity and an increased number of elderly have in- creased the prevalence of chronic and degenerative diseases associated with aging, including hypertension, diabetes, chronic kidney disease, and osteoporosis, as well as Alzhei- mer’s disease and other forms of dementia.11 The downside to improved health care and longevity is that one-third of the pop- FIGURE 1.1 Universal child immunization beginning in the 1950s ulation above 65 has multiple chronic conditions. Treatment dramatically reduced death from infectious disease in the United States. for chronic conditions in the elderly accounts for two-thirds of © Ilike/Shutterstock total healthcare costs in the United States. In the future, phys- ical and cognitive decline associated with aging will require methods, new tests to facilitate accurate diagnoses, and the personal assistance from family or paid caregivers and health treatment of individual diseases. The number of hospitals services from a variety of health professionals. In addition, by grew rapidly, and medical schools flourished. Within a few 2050 the population will also be more ethnically and racially years, medical care and patterns of disease had totally changed. diverse: one-third will be Hispanic non-white, one-third Af- The arrival of antibiotics in the 1940s and the implementation rican American, and one-third white.11 These changes will in- of childhood universal vaccination in the 1950s for measles, fluence the environment for new healthcare workers and the mumps, rubella, and polio signaled the end of the dominance diversity of those needing care. of acute infectious disease (FIGURE 1.1).8 By the late 1940s, chronic illnesses such as heart dis- ease and cancer accounted for nearly half of the deaths in A LOOK FORWARD the United States. By the 21st century, the development of Medicine must now confront the diseases and health prob- new drugs to control risk factors for heart disease, for exam- lems that are greatly influenced by the local and international ple, drugs to control hypertension, cholesterol, and diabetes, environment. Globalization and ease in international travel reduced death from heart disease by 28% between 2003 and increase the risk for infectious diseases. In the United States, 2013. During this same time, deaths from cancer also de- viral gastroenteritis is the most common viral infection and creased by 15% (FIGURE 1.2).9 salmonellosis is the most common bacterial infection—both 700 600 Per 100,000 Population 500 400 300 200 100 0 1950 1960 1970 1980 1990 2000 2010 2013 Heart disease CVD Cancer Influenza and pneumonia Diabetes mellitus FIGURE 1.2 Death rate for selected causes. Data from National Center for Health Statistics. 6 CHAPTER 1 U.S. Health Care 100 79.3 81.2 Life Expectancy at Birth, in Years 77.8 78.8 90 71.8 74.1 76.4 71.1 70 70 65.6 60 48.8 50 46.3 40 30 20 10 0 1900 1950 1980 1990 2000 2013 Year Male Female FIGURE 1.3 Life expectancy by year and sex. Data from National Center for Health Statistics. Health United States, 2014: With Special Features on Aged 55–64.Hyattsville, MD. 2015. organisms cause foodborne illness.12 Newly recognized infectious agents have caused substantial public health con- cern and investment. These include influenza H3N2, avian (bird) influenza, and Ebola, and some particularly virulent or drug-resistant bacterial strains, such as methicillin-resistant Staphylococcus aureus (MRSA). Influenza and pneumonia remain major causes of death, particularly among persons 65 years of age and older, and HIV/AIDS continues to spread. Although most infectious diseases are now prevented with vaccines and improved methods of infection control, new organisms continue to appear from mutations and transmission from wild animals or insects to domesticated animals and sometimes to humans. For example, in 2015 cases of avian flu were identified in Europe and China; in the United States, entire commercial poultry flocks required culling or removal of infected turkeys and chickens—and sometimes an entire flock was destroyed to prevent further spread of the disease, at great financial cost to the poultry business.13 FIGURE 1.4 Methicillin-resistant Staphylococcus aureus (MRSA) is a common cause of skin infection. The 2014 Ebola epidemic in West Africa, the largest in © Joseph Dilag/Shutterstock history, spread to the United States by healthcare workers employed in West Africa. The Centers for Disease Control and Prevention (CDC), the U.S. government agency that examples of healthcare workers involved in preventing the monitors infectious diseases, developed infection-control spread of infectious disease. measures for hospitals treating infected patients in the Most diseases of today are associated with personal United States. WHO and the CDC also deployed teams of lifestyle. Individuals can take responsibility for most life- experts to West Africa to implement infection-control mea- style factors such as physical activity, eating habits, smoking, sures to prevent further spread of the disease in Africa.14 drinking alcoholic beverages, using illicit drugs, personal hy- MSRA increases the risk for surgical infections, giene, and so forth. However, healthy communities are nec- pneumonia, and sepsis in hospitalized patients and requires essary to support individuals in achieving a healthy lifestyle. stringent infection control measures to prevent spread of the Disparities in health are related to lack of access to healthy bacteria causing the infection from patient to patient and food, safe housing, space for regular physical activity, educa- among healthcare workers (FIGURE 1.4).15 tion, employment, and health care. The National Prevention Epidemics of infectious disease require a team of ex- Council established seven priorities for preventive services to perts to track and contain diseases to prevent epidemics in improve the health and quality of life for all Americans of all both humans and animals. Physicians, nurses, veterinari- ages and to address health disparities (TABLE 1.1).16 ans, medical laboratory technologists, epidemiologists, and Two lifestyle factors associated with a high risk for public health officials at the local, state, and federal level are heart disease and cancer that can be changed are smoking  Impact of Technology on Healthcare Services 7 age received a combined vaccination series protecting them TABLE 1.1 National Prevention Strategy against nine infectious diseases. Only 41% of adults 18 years Priorities for Reducing Death and Major Illness and older received the influenza vaccine, and only 60% of adults over 65 years of age received a vaccine against pneu- Tobacco-free living monia.9 Preventing drug abuse and excessive alcohol use IMPACT OF TECHNOLOGY ON Healthy eating Active living HEALTHCARE SERVICES Preventing injury and violence Technology has made many new procedures and methods Reproductive and sexual health of diagnosis and treatment possible. Advances in medi- cal technology have improved the survival rates of trauma Mental and emotional well-being victims and the severely ill. Clinical developments, such as Data from National Prevention Council. National Prevention Strategy. infection control, less-invasive surgical techniques, and ad- June 2011. Internet: http://www.surgeongeneral.gov/priorities/pre- vances in reproductive technology, improve the quality of vention/index.html life. Drug therapy for managing chronic conditions—cancer, heart disease, and diabetes—has extended life for many and obesity.17 The good news is that the rate of smoking has Americans. Prescription drugs for treating mental illness dropped by more than half since 1970, when 45% of adults have allowed many to live in the community instead of be- over 18 years of age smoked compared to only 18% in 2013. ing hospitalized.10 Between 2007 and 2010, nearly half of all However, obesity rates continue to rise—only 30% of adults Americans took one or more prescription drugs. Factors that 20 years of age and older were at a healthy weight between have contributed to greater use of prescription drugs are the 2009 and 2012.9 growth of drug coverage by private and government health For the future, the predominance of chronic illness as the insurance—Medicare Part D (drug plans) was introduced in major threat to health raises many issues. The public concept 2006—and the ACA of 2010 made drugs more affordable.10 of health is that intervention by the doctor and early discov- The continuing surge of technological advances is not ery of disease will prevent or cure disease, when in fact health without problems. Medical technology can also prolong life is determined mainly by lifestyle. Optimal treatment for pre- for the critically ill, unresponsive patient who has little or no venting chronic illness requires health care that is long-term chance of recovery. Services such as mechanical ventilation, and continuous, yet health care in the United States is often kidney dialysis, parenteral (tube) feeding, and other means delayed until a chronic disease has been diagnosed. Although can keep even comatose patients alive. For the healthcare behavioral and environmental influences are the greatest con- system, dying can be extremely expensive. tributors to poor health, surgery and drugs are regarded as the The high cost of technology affects the financial struc- core of health care. The current method of financing health ture of the entire healthcare system. These increased costs are services emphasizes payment for specialized services—for ex- visible in the form of higher health insurance costs, higher ample, surgery or cardiac rehabilitation—instead of preven- costs for hospital stays, government payments to the sys- tive care, which may include referral to a dietitian for nutri- tem, and total medical bills. This advanced technology has tion counseling to lower weight and blood cholesterol levels. not only increased medical costs, but also created a social Funding for health care has traditionally focused on treatment and ethical problem. Because of limits in funding, advanced of chronic disease, such as hemodialysis treatment for chronic treatment is not available to all people. The poor, who may kidney disease—often the result of untreated or poorly con- need it desperately, have no access to it. trolled hypertension or diabetes. What is needed in health The incredible growth of technology has affected all the care is a redistribution of resources for the prevention of dis- health professions. Students entering the health field today ease, care of the acutely ill who require immediate treatment, recognize that they must excel academically and master and ongoing care for those with chronic diseases. technical skills. Less time is spent learning personal, non- Preventive healthcare services improve health by pro- technical aspects of care. This value system is reinforced by tecting against disease, lessening the impact of disease, or professionals, peers, and administrators, and by the public detecting disease at an early stage when it is easier to treat. as well. Excellent technical performance has become a stan- As a result of requirements to include preventive services by dard, at the cost of the personal, human touch. insurance plans purchased through Health Exchanges un- The federal government plays an increasingly powerful der the ACA and coverage by Medicare, clinical preventive role in the direction of health care. It dominates the health- services are being utilized by more Americans. For exam- care system by virtue of its expanding monetary support of ple, immunizations and cancer screening—e.g., mammog- technology and services, and because it sets the rules for the raphy and colonoscopy—are the most common preventive provision of health care. services. However, utilization remains suboptimal for some As health services enter the 21st century, it becomes services. In 2013, only 70% of children 19 to 35 months of apparent that the social philosophy of the 20th century is 8 CHAPTER 1 U.S. Health Care obsolete and is moving toward a philosophy that holds high healthcare costs. New technology makes it possible society, through the government, responsible for organizing to identify genes for these brain diseases—Alzheimer’s, and maintaining adequate health care for all people. Health Parkinson’s disease, epilepsy, ASD, traumatic brain in- care was once considered an individual matter, but it is now jury, and psychiatric disorders such as schizophrenia and considered a right to which everyone should have access. depression—as well as capture images of the brain to de- velop treatment for such diseases.20 Awareness of the need for pain control and freedom to make choices about treat- TRENDS THAT WILL IMPACT ment for those with life-limiting illnesses is beginning to shift the focus of both patients and physicians from cura- HEALTH SERVICES AND tive therapy to quality of life and greater use of palliative HEALTH CAREERS and hospice services.21 Changes in disease patterns and methods of diagnosis and Health information technology (health IT) is chang- treatment impact the demand for health services and health- ing the way healthcare workers practice their profession, care workers. The Human Genome Project has identified and even more changes are expected in the future. First gene mutations that transmit risk for disease and response steps were using Electronic health records (EHRs) in hos- to drugs used to treat disease. The lower cost of genetic test- pitals that linked data from physicians, pharmacy, clinical ing and coverage by health insurance have made it possible laboratories, and imaging as well as documentation by all for this technology to be available for more people. This new health professions. EHRs make it possible for multiple team information allows a physician to ask patients for a family members to schedule a patient-team conference regardless disease history and order DNA testing to target preventive of physical location. Remote monitoring of patient clinical measures specific to the disease. Genetic counselors play an data—for example, blood pressure and blood glucose—al- important role in counseling patients about DNA testing to lows healthcare workers to provide care after the patient is identify risk for disease as well as treatment interventions.18 discharged from the hospital. Sharing of EHRs among dif- Public health research shows that more and more chil- ferent providers for the same patient—hospital, emergency dren are being diagnosed with Autism spectrum disorders room and outpatient clinic—has the potential for improv- (ASD) with 1 in 68 children in the U.S. being given this di- ing patient safety by avoiding drug interactions and reduc- agnosis. Children with ASD are often treated by a team of ing costs by avoiding duplicate laboratory tests.22 The federal health professionals, including occupational therapists, government uses data to monitor outcomes such as hospi- speech therapists, and applied behavior analysis (ABA) tal readmission rates and surgical complications, as well as therapists (FIGURE 1.5).19 healthcare costs. Many diseases of the brain cause disabilities that impact productivity and quality of life and contribute to SUMMARY To improve the health of all Americans, it is critical to con- tinue collecting data on all components of health; document- ing trends in risk factors, health status, and access to and utilization of healthcare services; and disseminating reliable and accurate information about the health of our popula- tion. Equally important is gaining an understanding of the healthcare needs and utilization patterns of population sub- groups, especially with changes in access to health care with healthcare reform. Such insights will enable policy makers to set program priorities and allocate target resources most effectively. Healthcare and population trends and healthcare reform will affect all health professionals in every career and will change the practice of medicine as we know it. Because there is no single “U.S. healthcare system,” the many ways in which health care is delivered can be puzzling. This should not be surprising, given the historical perspec- tive of health services, the diverse subsystems in operation in FIGURE 1.5 Autism spectrum disorders (ASD) affects 1 in 68 children in the United States. the United States, and the dynamics of social and technolog- © JGA/Shutterstock ical changes.  Learning Portfolio 9 LEARNING PORTFOLIO Study Points Issues for Discussion 1. As a result of the 2010 Affordable Care Act (ACA), 1. Discuss changes in access to health care in the United more Americans had access to health insurance through States as a result of the Affordable Care Act of 2010. Health Exchanges, Medicaid, or the Children’s Health 2. Discuss how the causes of death have changed since Insurance Program (CHIP). As a result of new Health 1900 in the United States. Discuss three major factors Exchanges, 6.7 million Americans obtained health insur- that have contributed to this change. ance in 2014 and 11.7 million were enrolled in 2015. An 3. Discuss the role of government in providing access to additional 11 million low-income adults and children health care through legislation and financial support received health care through Medicaid or CHIP in 2015. of health care and technology. 2. Health problems during the 1800s were related to 4. Discuss the pros and cons of requiring all children to contaminated food and water and inadequate sewage receive immunizations as a prerequisite to enrolling in disposal resulting in epidemics and deaths from chol- school. era and yellow fever. 5. Discuss the role of Health information technology 3. Both longevity and infant mortality statistics im- (health IT) in monitoring the quality and cost of proved with improvement in sanitation and universal health care in the United States. What are the advan- immunization; by 1950, the principal causes of death tages and disadvantages of using HIT? changed from infectious diseases to the chronic dis- eases of heart disease and cancer. Enrichment Activities 4. By the 21st century, the decrease in death rates among the elderly was significant. These declines were related 1. Methicillin-resistant Staphylococcus aureus (MRSA) is a to improved drug treatment for heart disease and can- cause of skin infection in the community, for example in cer and lower smoking rates. high schools and day care centers. Review information from the CDC (MRSA in the Community: http://www. 5. The consequence of improved longevity is a greater cdc.gov/mrsa/community/index.html) to learn how number of elderly with multiple chronic and degenera- MRSA can be transmitted in the community setting. tive diseases; treatment for these conditions account for two-thirds of total healthcare costs in the United States. 2. Use obesity prevalence maps from the CDC (Obesity and Overweight: http://www.cdc.gov/obesity/data/ 6. Clinical preventive services (cancer screening and prevalence-maps.html) to learn more about obesity immunizations) are more accessible because of pro- in the United States, including the state in which you visions of the Affordable Care Act, but not all Ameri- live. Which states have the highest rates of obesity, cans take advantage of these services. and which states have the lowest rates of obesity? 7. New infectious diseases of domesticated animals and 3. Explore CDC Vital Signs to learn more about differ- humans continue to emerge and require monitoring ences in cigarette smoking across states and different and infection-control measures to prevent epidemics. groups within the United States (Tobacco Use & Sec- 8. Over 50% of the causes of death are related to per- ond Hand Smoke. CDC Vital Signs. September 2010: sonal lifestyle choices: diet, physical activity, tobacco http://www.cdc.gov/vitalsigns/TobaccoUse/Smoking/ and alcohol use, illicit use of drugs, and motor vehicle index.html). Learn more about the health risks of traffic fatalities. smoking and secondhand smoke. 9. Greater use of prescription drugs are the result of 4. Learn more about the role of genomics from the drug coverage by private and government health in- CDC’s Healthy People 2020 website (http://www. surance—Medicaid, CHIP, Medicare, and the ACA. healthypeople.gov/2020/topics-objectives/topic/ 10. The Human Genome Project will increase under- genomics). Which diseases have a strong relationship standing of diseases of the brain needed to develop to genomics, and how can this information be used by improved methods of diagnosis and treatment. consumers and physicians to prevent disease? 11. Health information technology (health IT) improves 5. Review the article Global Health in the Clinical Labora- communication and efficiency in providing health tory (Critical Values. 8:24-27, April 2015: http://www. care and will increasingly be used by the government ascp.org/Newsroom/Critical-Values.html) to learn how to monitor the quality and cost of healthcare delivery. Emory University in Atlanta, Georgia prepared to accept 12. Factors that will influence current and future health- and treat patients traveling from West Africa who were care occupations are changes in disease patterns and infected with the Ebola virus. What special isolation pro- treatment and access to health care. cedures were used? 10 CHAPTER 1 U.S. Health Care LEARNING PORTFOLIO References 1. Office of the Legislative Counsel, U.S. House of Representa- 10. National Center for Health Statistics. Health, United States, tives. Compilation of Patient Protection and Affordable Care 2013. With Special Features on Prescription Drugs. Hyatts- Act. 111th Congress, 2d Session. May 10, 2010. Internet: ville, MD: NCHS; 2014. http://housedocs.house.gov/energycommerce/ppacacon.pdf 11. Centers for Disease Control and Prevention. The State of 2. Goodman DC, Brownlee S, Chang C-H, Fisher E. Regional Aging and Health in America 2013. Atlanta, GA: CDC; and Racial Variation in Primary Care and the Quality of 2013. Care Among Medicare Beneficiaries. A Report of the Dart- 12. Smith KF, Goldberg M, Rosenthal S, Carlson L, Chen J, mouth Atlas Project. Hanover, NH: Dartmouth Institute for Chen C, Ramachandran S. Global Rise in Human Infectious Health Policy and Clinical Practice Center for Health Policy Disease Outbreaks. J R Soc Interface. 2014; 11(101):20140950. Re