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Includes resources or structures needed to deliver quality health care, for example, human and physical resources, such as nurses and nursing and medical practitioners, hospital buildings, medical records, and pharmaceuticals.
Includes the quality activities, procedures, tasks, and processes performed within the health care structures, such as hospital admissions, surgical operations, and nursing and medical care delivery following standards and guidelines to acheive quality outcomes.
The results of good care delivery acheived by using quality structures and quality processes and includes the achievement of outcomes such as patient satisfaction, good health and functional ability, and the absence of health care acquired infections and morbidity.
Emphasizes seven important features. Care that is:
- Community oriented
- Family centered
- Culturally competent
- Begun at first contact with the patient
Health care providers raise prices for the privately insured to offset the lower health care payments from both Medicare and Medicaid as well as the often nonpayment of health care premiums from the uninsured.
The payment of a fixed dollar amount, per person, for the provision of health care services to a patient population for a specified period of time.
A method of reimbursement in which Medicare payment is made based on a predetermined, fixed amount for reimbursement to acute inpatient hospitals, home health agencies, hospices, hospital out-patient and inpatient psychiatric facilities, inpatient rehab facilities, long-term hospitals, and skilled nursing facilities.
Total Quality Improvement (TQI)
Continuous Quality Improvement (CQI)
Preferred Provider Organization (PPO)
A PPO generally consists of a hospital and a number of practitioner providers. The PPO contracts wit health care providers and payers to provide health care services to a defined population for predetermined fixed fees.
Usually a third-party reimburser (insurance company or government). In a private pay scenario, the patient is the buyer and the payer.
Failure to rescue
The clinicians inability to save a patient's life when the patient experiences complications.
- Nursing or medical surveillance systems fail to act on signs of a complication in a timely manner, resulting in a missed opportunity or seriously delayed rescue effort.
Necessary supplies and equipment are not ready when a patient presents with a problem.