D is correct.Rationale: The national organization that accredits health care organizations is known as (D) Joint Commission. (A) The ANA is the professional nurses association. (B) Health professions Commission, and (C) the Agency for Health Care Research and Quality do not accredit health care organizations.2 Answer D: is correct.Rationale: The largest purchaser of health care in America is (D) Medicare, Medicaid, and other governmental programs. (A) Private individuals, (B) Private insurance companies, and (C) Health Maintenance Organizations are not the largest purchaser.
3 Answer: B is correct.Rationale: (B) Donabedian identified a structure, process, and outcome framework for quality. The others, (A) Nightingale, (C) Starr, and (D) Lohr did not.
4 Answer: A is correct.Rationale: (A) Socioeconomic status is the top underlying cause of health care disparity in the United States, so (B) age, (C) geographical location, or (D) chronic illness are all incorrect.
5 Answer: A is correct.Rationale: Payment for health care services as a fixed dollar amount per member over a period of time is referred to as (A) traditional fee for services, so not (B) prospective payment system, (C) capitation, or (D) diagnostic related groupings.
6 Answer: B, C, D, E, and F are correct answers.Rationale: The Patient Protection and Affordable Care Act provides comprehensive health care reform through a number of initiatives, including all except (A) restricting in‐patient hospital stays. (B) Expanding health insurance coverage, (C) targeting fraud, abuse, and waste in health care, (D) increasing access to primary care services, and (E) promoting preventive health strategies, are all correct.
7 Answer: A, B, C, D, and E are correct answers.Rationale: Key factors contributing to rising health care costs in the United States include (A) an aging population, (B) advancements in technology, (C) increased utilization of pharmaceuticals, (D) rising costs of primary care, and (E) administrative costs.
8 Answer: A is correct.Rationale: The competencies for the education of health care professionals recommended by the Institute of Medicine to improve the quality of health care include all except (A) primary care settings. They do include (B) a patient‐centered approach, (C) use of health information technology, or (D) evidence‐based practice.
9 Answer: B is correct.Rationale: The link between adverse patient outcomes and cleanliness was discovered by (B) Florence Nightingale, not (A) W. Edwards Deming, (C) Isabel Hampton Robb, or (D) Dorthea Dix.
10 Answer: C is correct.Rational: The three components of health care systems are: (1) structure (resources or “structures” required to deliver health care), (2) process (quality activities, procedures, and tasks performed to deliver quality health care), and (3) outcome (the results of good health care delivery). Therefore (A), (B), and D are all incorrect.
REVIEW ACTIVITIES
1 Although it is difficult to modify the entire structure of health care in the U.S., what could you do to modify the process of health care delivery to improve health care quality in your organization?
2 What strategies can be used to ensure patient access to appropriate health care services in public and private health care agencies?
3 How can the five IOM health professions competencies and the need for safe, high‐quality care be achieved in health care organizations?
DISCUSSION POINTS
1 Are all adverse events inevitable?
2 How is the FDA involved in improving patient safety?
3 Do sentinel events have to be reported to TJC?
4 What are the similarities in the measures of patient safety and the measures of quality of care?
5 Should only events that harm patients be reported to external quality and safety organizations?
6 Do patients have better outcomes when they stay in the hospital longer?
7 Name three of the QSEN competencies.
8 Does blaming a nurse for an error improve patient safety?
9 Name the six aims of the health care system from the IOM Crossing the Quality Chasm 2001 report.
10 Is improving quality and patient safety expensive?
DISCUSSION OF OPENING SCENARIO
With the ongoing debate about the cost and importance of everyone throughout the nation having access to health care, regardless of ability to pay, concern continues among the disadvantaged or low income groups about their future ability to access health care services. Unfortunately, this is a common scenario for all too many Americans. As the only industrialized nation in the world without UHC, the rising costs of health care, and the challenges of being able to access care at any time or any place, many in our nation will continue to be exposed to situations where the outcomes could have been better. As nurses, we may assume that patients will do the right thing when it comes to their health or the health of those that depend upon them. With experience and understanding of health care research, we know this is not always the case. We have tremendous opportunities to make needed changes in how health care can be accessed and payed for, as well as helping patients understand how they can best navigate the health care system.
EXPLORING THE WEB
FEDERAL GOVERNMENT:
Agency for Healthcare Research and Quality (AHRQ): www.ahrq.gov
Centers for Disease Control and Prevention (CDC): www.cdc.gov
Centers for Medicare and Medicaid Services (CMS): www.cms.gov
Department of Defense (DOD) TRICARE program: www.tricare.mil
Food and Drug Administration (FDA): www.fda.gov
Health Resources and Services Administration (HRSA): www.hrsa.gov
Indian Health Service (IHS): www.ihs.gov
National Center for Health Statistics: www.cdc.gov. Search for National Center for Health Statistics.
National Guidelines Clearinghouse: www.guidelines.gov
National Institutes of Health (NIH): www.nih.gov
Substance Abuse and Mental Health Services Administration (SAMHSA): www.samhsa.gov
Veterans' Health Administration (VHA): www.va.gov
PRIVATE FOUNDATIONS AND ORGANIZATIONS:
Commonwealth Fund: www.cmwf.org
Henry J. Kaiser Family Foundation (KFF): www.kff.org
Joint Commission (JC): www.jointcommission.org
National Committee for Quality Assurance (NCQA): www.ncqa.org
National Quality Forum (NQF): www.qualityforum.org
Robert
