OSI test 3

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OSI test 3
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OSI test 3
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  1. who does the right thing
    leaders
  2. who does thing right
    managers
  3. 5 leadership "what counts" factors
    • recognizes opportunities
    • forms a vision of what can be achieved
    • challenges self and others to get the desired result
    • champions ideas and people to get breakthrough results
    • uses a variety of resources effectively
  4. 3 E's of leaders
    • envision
    • energize
    • empower
    • execute
  5. creating the future, gaining enrollment, alignment, and commitment
    envision
  6. creates a picture of the futrue and keeps the vision alive
    focuses on possibilities-NOT limitations
    enrolls and focusses the organization on the key objectives and winning strategies
    personally comunicates the vision and what he/she stand for both in word and action
    envision
  7. strategy development
    business knowledge/expertise
    bench marking
    breakthrough thinking
    are ways of accomplishing what
    envision
  8. inspiring people to deliver the future
    energize
  9. strategy development
    effective communication
    work and development plans
    managing conflict
    symbolic interventions
    embody it
    are ways to accomplish what
    energize
  10. building peoples capability to achieve business results
    enable
  11. periodic reviews
    delegate accountability
    situational leadership
    rewards and recognition
    are ways to accomplish what?
    enable
  12. having a guided, measurable plan and following through with it
    execution
  13. who was the former CEO of P&G
    john pepper
  14. approx how many physicians are active and which level of pyramid are they and physicians completing residency work where
    • 873,000
    • 33% primary care
    • 67% non-primary
    • 90% residency goers are in patient care
  15. who regulates the licensing of physicians
    states - medical boards
  16. where does funding for medical schools come from
    individual states
  17. where does funding fo residencies come from
    federal government
  18. first new type of medical education center (1893)
    Johns Hopkins University School of Medicine
  19. what is the Flexnor report of 1910
    a study (by AMA & Andrew Carnegie)comparing medical educations at proprietary non-university setting to John Hopkins
  20. emphasizes mechanical manipulation of the body by therapeutic maneuvers
    • osteopathy
    • developed in Missouri by Andrew Still in 1890's and they have their own accrediting organization
  21. First PA training program
    • Duke University School of Medicine in 1965.
    • vietnam vets who worked as medical corpsman
  22. stipulation of PA practices
    perform under physician supervision - delegated authority
  23. largest health profession in the USA
    registered nurses
  24. Primary employmet setting fo registered nurses
    • hospitals - 62%
    • ambulatory/community care - 25%
    • long term care - 5%
  25. in 2008 what degree did the majority of active nurses obtain
    • associate - 45%
    • baccalaureate - 34%
    • diploma - 20%
  26. did the number of nurse practitioners increase of decrease from 1992-1997
    • exploded!
    • 1500 in 1992
    • 8000 in 1997
  27. is there a national licensing exam for NPs
    no, administered by different organizations and are specialty specific
  28. what level of education does a NP generally have
    2 years masters degree who previously attended baccalaureate degree's in nursing
  29. education level of a Doctor of Nursing Practice
    4 year graduate expeience following bachelors in nursing
  30. trend of social workers from 2008-2018
    increase from 640,000 to 745,000
  31. what setting do social workers generally come into play
    transition from hospital to home and hospital to extended care facility
  32. minimal educational requirement for social workers
    bachelor's, but most require a masters in social work plus state licensure
  33. licensed cliinical social workers level of education
    masters plus 2 years of academic practical experience in the field
  34. top 6 healthcare professions
    • registered nurses
    • physicians
    • pharmacists
    • dentists
    • physical therapists
    • nurse practitioners
  35. workforce demographics from 1975-2005 for registered nurses
    physicians
    pharmacists
    • doubled
    • increase by 75%
    • increased by 50%
  36. 2 parts to the equation to the supply of healthcare professionals
    • 1. adequacy of workforce
    • 2. judgment about how many physicians, nurses, or pharmacists are actually required
  37. 2 schools of thought on workforce shortages
    • 1. market deman
    • 2. workforce requirements
  38. In 2010 what was the proportion of women in the fields of nursing, pharmacy and physicians
    • nurse 90%
    • pharmacy 50%
    • physicians 30%
  39. number of professionally active PA's in the USA
    60,000
  40. 5 tasks of social workers
    • assessing person,behavioral,family/work situations
    • connecting pts to medical equipment and in-home services
    • nursing home/extended care placements
    • investigation neglect and abuse
    • helping with insurance
  41. supply of active physicians, nurses and pharmacists per 100,000 population in 2010
    • physician - 210,000 (150,000 specialists and 60,000 generalists)
    • nurses - 800
    • pharmacists - 75
  42. 2 main pharmacy practice settings
    • retail - 60%
    • hospital - second largest
  43. percent of pts that experience a medical injury while in the hospital (harvard)
    13.8%
  44. of injuries leading to death what percent involved negligence (harvard)
    51%
  45. 6 core quality dimensions of health care
    • safe
    • timely
    • effective
    • efficient
    • equitable
    • patient-centered
  46. triad of traditional quality assurance
    • licensure
    • peer review
    • accreditation
  47. 3 criteria for accreditation
    • structural - working condition of defibrillator
    • process - medical records dictated and signed in a timely manner
    • outcomes - mortality rates, preventable wound infections, rates of sdverse drug reactions
  48. guidlines created in 1989 to improve quality of clinical outcomes
    agency for healhcare research and quality (AHRQ)
  49. what 2 things should practice guidelines take into account
    • scientific data
    • patient preferences
  50. 2 basic indicators of improving quality
    • process measures - types of service delivered by caregivers
    • outcome measures - death, symptoms, mental health, etc
  51. what does medicare pay for in terms of care
    pays for skilled care by not custodial care
  52. what is the limiting factor of private long term coverage
    Experience rating - median income of >65 is 31,000. 1 year in nursing home stay around 76,000
  53. what happened in medicaid that provided more care to try and prevent nursing home admissions
    • 1915 (c) waivers
    • oregon allocated 71% of long-term medicaid dollars to this program
  54. what is community-based & home health services
    intermediate between the home and the nursing home trying to keep people independent as long as possible while still receiving necessary care
  55. omnibus budget reconciliation act of 1987
    • set standards for nursing home quality
    • mandated surveys for enforcement
  56. pepper commission 1990
    • bipartisan commission to address LTC
    • financed by increasing social security
    • would help with ADL's & IADL's
  57. On Lok
    • long term care in the chinese community caring for the frail elderly.
    • received capitated payments from the Medi's
    • less nursing home and more ambulatory and community based services
  58. describe the 3 levels of health promotion & disease prevention
    • 1 - increase socioeconomic status to decrease chronic care expenditures
    • 2 - population attempt (public health)
    • 3 - prevention on an individual level (preventive interventions (pri. and sec.) by primary care providers) 
  59. first epidemiological revolution
    • 19th century, infectious diseases that could be prevented and improve overall quality of life.
    • immunizations & improved living standards through public health measures
  60. second epidemiological revolution
    • cancer, heart diseas  & stroke
    • 1980 - 2006 big push to address these because they were largely preventable
    • also addressed risk factors that was implicated for 37% of the deaths
  61. 3 risk factors that were implicated for 37% of the deaths in the second epidemiological revolution
    • tobacco (435,000 deaths)
    • high fat diet and inactivity (365,000 deaths)
    • alcohol (85,000 deaths)
  62. second epidemiological revolution effects on coronary heart disease
    decreased by 61% and associated with reduced rates of tobacco use and lowered mean cholesterol levels
  63. 2 models on perspectives on chronic disease prevention and populations targeted
    • medical model - high risk individuals
    • public health model - disease in populations as a whole
  64. advantage of the public health model over the medical model
    targeting a large number of people at small risk for disease can reduce a larger portion that could progress to high risk rather than targeting a small number who are already high risk
  65. what do the two models of chronic disease prevention have to do with physicians
    changes our focus from the top heavy specialists to the smaller portion of generalists and focuses on prevention
  66. 4 major risk factors for coronary heart disease
    • eating a rich diet
    • elevated levels of serum cholesterol
    • cigarette smoking
    • hypertension
  67. which medical model was most effective in the anti-smoking campaing of the last 30 years
    • public health
    •    public education
    •    cigarette taxes
    •    restriction of smoking in public places
  68. is drug Tx of CHD with statins more effective in primary or secondary prevention
    secondary
  69. screening and early detection of elevated blood pressure is what prevention of HTN
    secondary
  70. screening and early detection of elevated blood pressure is what prevention for coronary artery disease
    primary
  71. 6 risk factors for breast cancer
    • >65 yo
    • family history
    • atypical hyperplasia on breast biopsy
    • birth in north america or northern europe
    • genetic suseptibility - BRCA genotype
    • women with more menstrual cycles
  72. which type of prevention has the highest return on investment (ROI)
    primary - increased primary prevention can add up to 50% savings
  73. 3 primary prevention that lead to 3 reduced disease states
    • smoking prevention
    • cholesterol reduction
    • BP management

    • coronary heart disease
    • cancer
    • stroke
  74. 5 points on the cost savings slide
    • 1. cost effectiveness data complex and mixed
    • 2. primary prevention via public health measures more cost effective than primary prevention via medical care
    • 3. public health measures avert millions of expensive one on one interactions with medical care providers
    • 4. HIGH ROI for measles mumps and rubella immunizations
    • 5. HIGH ROI for physician counseling on smoking cessation
  75. 3 areas rated on for pay for performance in the integrated healthcare association in california
    • clinical care
    • patient satisfaction
    • development of information technology

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