mhis chapter3 healthcare settings

Chapter 3Chapter 3HEALTHCARE SETTINGSHEALTHCARE SETTINGS

ObjectivesObjectivesAt the end of this chapter, the student should be able to:At the end of this chapter, the student should be able to:

1.1. List and define hospital categories List and define hospital categories 2.2. Identify types of hospital patientsIdentify types of hospital patients3.3. Differentiate among freestanding, hospital-based, and hospital-Differentiate among freestanding, hospital-based, and hospital-

owned ambulatory care settings owned ambulatory care settings 4.4. Distinguish among various types of behavioral health care facilities Distinguish among various types of behavioral health care facilities 5.5. Detail services provided by a home care agency Detail services provided by a home care agency 6.6. Describe the goal of hospice care Describe the goal of hospice care 7.7. Explain the various types of longterm care Explain the various types of longterm care 8.8. Differentiate between the various managed care Differentiate between the various managed care

models models 9.9. Name and describe of governmental health care facilities Name and describe of governmental health care facilities 10.10. Compare the responsibilities of agencies within the Compare the responsibilities of agencies within the

Public Health Services Public Health Services

HEALH CARE DELIVERY SYSTEMHEALH CARE DELIVERY SYSTEM

05/03/233Dr.Mazen Maswady

The Basic Requirements for The Basic Requirements for Sound Healthcare (the 8 A’s and Sound Healthcare (the 8 A’s and the 3 C’s)the 3 C’s)

AppropriatenessAppropriatenessAvailability Availability AdequacyAdequacyAccessibilityAccessibilityAcceptabilityAcceptabilityAffordability Affordability

AssessabilityAssessabilityAccountabilityAccountabilityCompletenessCompletenessComprehensivenessComprehensivenessContinuityContinuity


The basic requirements for good health careThe basic requirements for good health care

The basic requirements for good health care can be summarized by a The basic requirements for good health care can be summarized by a list of terms called the 7 A's and the 3 C's.list of terms called the 7 A's and the 3 C's.

AvailabilityAvailability: means that health care can be obtained during the hours : means that health care can be obtained during the hours and days when people need it.and days when people need it.

Adequacy:Adequacy: is a sufficient volume of care to meet the need and demand is a sufficient volume of care to meet the need and demand of a community.of a community.

Accessibility:Accessibility: refers to geographic, physical (e.g., for refers to geographic, physical (e.g., for handicapped persons), and financial accessibilityhandicapped persons), and financial accessibility

Acceptability:Acceptability: of care depends on a variety of factors, such as whether of care depends on a variety of factors, such as whether (1) the providers can communicate well with their patients (including (1) the providers can communicate well with their patients (including whether they can speak the patients' languages),whether they can speak the patients' languages),

(2) the care is seen as warm and humane and concerned with(2) the care is seen as warm and humane and concerned with the the whole person, andwhole person, and

(3) the patients believe(3) the patients believe in the confidentiality and privacy of information in the confidentiality and privacy of information shared with their providers.shared with their providers.



Appropriateness:Appropriateness: of care means that the procedures being of care means that the procedures being performed are properly selected and carried out by trained performed are properly selected and carried out by trained personnel in the proper setting. personnel in the proper setting.

Assessability:Assessability: means that the health care can be readily means that the health care can be readily evaluated. Care can be assessed more efficiently if the medical evaluated. Care can be assessed more efficiently if the medical records are complete and if basic care information is available in records are complete and if basic care information is available in linked computer databases.linked computer databases.

Accountability:Accountability: has to do with public accountability. Are the has to do with public accountability. Are the members of the community and the people with a stake in the members of the community and the people with a stake in the functioning of the institution represented on the board of directors functioning of the institution represented on the board of directors of a facility?of a facility?

6Dr.Mazen Maswady 05/03/23


Completeness: Completeness: of care requires adequate attention to all of care requires adequate attention to all aspects of a medical problem. Complete care includes aspects of a medical problem. Complete care includes health promotion, disease prevention, early detection of health promotion, disease prevention, early detection of diseases, and appropriate diag nostic and treatment diseases, and appropriate diag nostic and treatment measures, including follow-up care and rehabilitation.measures, including follow-up care and rehabilitation.

Comprehensiveness: Comprehensiveness: of care means that care is provided of care means that care is provided for all types of health problems, includ ing dental and mental for all types of health problems, includ ing dental and mental health problems. If health problems. If therethere are major exclusions, such as for are major exclusions, such as for psychiatric or substance abuse care, the coverage cannot psychiatric or substance abuse care, the coverage cannot be considered comprehensive.be considered comprehensive.

Continuity of care: Continuity of care: requires that the management of a requires that the management of a patient's care over time be coordinated among providers. Is patient's care over time be coordinated among providers. Is there one physician or other provider who is basically in there one physician or other provider who is basically in charge of a patient's care, who sees the patient regularly charge of a patient's care, who sees the patient regularly and ensures that there are no major omissions or and ensures that there are no major omissions or redundancies in the careredundancies in the care


Affordability (8 Cs Approach) Affordability (8 Cs Approach)

The cost should be within the means and The cost should be within the means and resources of the individual and the country.resources of the individual and the country.


Basic Levels of HealthcareBasic Levels of Healthcare

Primary health carePrimary health care

The “first” level of contact between the The “first” level of contact between the individual and the health system.individual and the health system.

Essential health care (PHC) is provided.Essential health care (PHC) is provided. A majority of prevailing health problems A majority of prevailing health problems

can be satisfactorily managed.can be satisfactorily managed. The closest to the people.The closest to the people. Provided by the primary health centers.Provided by the primary health centers.


Basic Levels of HealthcareBasic Levels of Healthcare

Secondary health careSecondary health care More complex problems are dealt with.More complex problems are dealt with. Comprises curative servicesComprises curative services Provided by the district hospitalsProvided by the district hospitals The 1The 1stst referral level referral level

Tertiary health careTertiary health care Offers super-specialist careOffers super-specialist care Provided by regional/central level Provided by regional/central level

institution.institution. Provide training programsProvide training programs


Levels of the Medical Care System from the Most Levels of the Medical Care System from the Most Complex (I) to the Least Complex (5)Complex (I) to the Least Complex (5)

1)1) Acute general hospital facilities:Acute general hospital facilities:A.A. Tertiary medical center (with most or all of the latest (technology)Tertiary medical center (with most or all of the latest (technology)B.B. Intermediate hospital (medium to large community hospital with a considerable amount of Intermediate hospital (medium to large community hospital with a considerable amount of

the latest technology)the latest technology)C.C. Local community hospitalLocal community hospital2)2) Rehabilitation or convalescent care facilitiesRehabilitation or convalescent care facilitiesA.A. Special unit in a regular hospital Special unit in a regular hospital B.B. Rehabilitation hospitalRehabilitation hospital3)3) Extended care facilitiesExtended care facilitiesA.A. Skilled nursing facility ("nursing home") Skilled nursing facility ("nursing home") B.B. Intermediate care facilityIntermediate care facilityC.C. HospiceHospice4)4) Organized HomecareOrganized HomecareA.A. Public agencies (local health departments or visitingPublic agencies (local health departments or visiting

nurse associations) nurse associations)B.B. Private organizationsPrivate organizations5)5) Self-care in the homeSelf-care in the home

1105/03/23

Dr.Mazen Maswady

HEALH CARE DELIVERY SYSTEMHEALH CARE DELIVERY SYSTEM


General HospitalGeneral Hospital

Facility where patients are Facility where patients are hospitalized a short time (few hospitalized a short time (few days to a few weeks)days to a few weeks)

Provide a wide range of Provide a wide range of diagnostic, medical, surgical, diagnostic, medical, surgical, and emergency servicesand emergency services

Most small town hospitals are Most small town hospitals are classified as general hospitalsclassified as general hospitals


ACUTE CARE FACILITIES (HOSPITALS) ACUTE CARE FACILITIES (HOSPITALS)

An acute care facility (ACF) is a hospital that provides health care An acute care facility (ACF) is a hospital that provides health care services to patients who have serious, sudden, or acute illnesses or services to patients who have serious, sudden, or acute illnesses or injuries and/ or who need certain surgeries. ACFs provide a full range of injuries and/ or who need certain surgeries. ACFs provide a full range of health care services, including ancillary services, emergency and critical health care services, including ancillary services, emergency and critical care, surgery, obstetrics (labour and delivery), and so on. Ancillary care, surgery, obstetrics (labour and delivery), and so on. Ancillary services are diagnostic and therapeutic services provided to inpatients services are diagnostic and therapeutic services provided to inpatients

Medical, nursing, and other health-related services to patients with Medical, nursing, and other health-related services to patients with surgical and nonsurgical conditions; they usually also provide some surgical and nonsurgical conditions; they usually also provide some outpatient services. Hospitals are categorized as (1) single outpatient services. Hospitals are categorized as (1) single hospitals (hospital is self-contained and not part of a larger organization) hospitals (hospital is self-contained and not part of a larger organization) and (2) multi-hospital systems (two or more hospitals owned, managed, and (2) multi-hospital systems (two or more hospitals owned, managed, or leased by a single organization; these may include acute, longterm, or leased by a single organization; these may include acute, longterm, paediatric, rehabilitation, and/ or psychiatric care facilities). paediatric, rehabilitation, and/ or psychiatric care facilities).

1405/03/23

Dr.Mazen Maswady

General hospitals provide emergency care, perform general General hospitals provide emergency care, perform general surgery, and admit patients for a range of problems from fractures surgery, and admit patients for a range of problems from fractures to heart disease, based on licensing by the government. to heart disease, based on licensing by the government.

The hospital bed size (or bed count) is the total The hospital bed size (or bed count) is the total number of inpatient beds for which the facility li- number of inpatient beds for which the facility li- censed by the state; the hospital must be equipped censed by the state; the hospital must be equipped and staffed to care for these patient admissions. The and staffed to care for these patient admissions. The hospital's average length of stay (LOS) determines hospital's average length of stay (LOS) determines whether the hospital stay is classified as short-term or whether the hospital stay is classified as short-term or acute, with an average LOS of 4 to 5 days and a total acute, with an average LOS of 4 to 5 days and a total LOS of less than 25 days, or long-term, with an aver- LOS of less than 25 days, or long-term, with an average LOS of greater than 25 days. age LOS of greater than 25 days.

15




Hospitals are also categorized by the following Hospitals are also categorized by the following types: types:

Critical access hospitals (CAHs) are those located Critical access hospitals (CAHs) are those located more than 35 miles from any other hospital or another CAH, more than 35 miles from any other hospital or another CAH,

CAHs must provide emergency services 24 hours a day and CAHs must provide emergency services 24 hours a day and maintain no more than 15 inpatient beds (except for swing-bed maintain no more than 15 inpatient beds (except for swing-bed facilities, which can have up to 25 inpatient beds if no more than facilities, which can have up to 25 inpatient beds if no more than 15 are used at anyone time for acute care)15 are used at anyone time for acute care)

General hospitals provide emergency care, perform general General hospitals provide emergency care, perform general surgery, and admit patients for a wide range of problems from surgery, and admit patients for a wide range of problems from fractures to heart disease, based on licensing by the state. fractures to heart disease, based on licensing by the state.

1605/03/23

Dr.Mazen Maswady

Specialty HospitalsSpecialty Hospitals Provide care for specific chronic illnesses Provide care for specific chronic illnesses Patients are usually hospitalized for a long time.Patients are usually hospitalized for a long time. Specialty hospitals concentrate on a particular Specialty hospitals concentrate on a particular

population of patients (e.g., children) or disease population of patients (e.g., children) or disease category (e.g., cancer). category (e.g., cancer).

King Saud Specialty Hospitals in Saudi Arabia is King Saud Specialty Hospitals in Saudi Arabia is one exampleone example

05/03/23 17Dr.Mazen Maswady

Rehabilitation CentersRehabilitation Centers

People who have been disabled by sickness or injury can recover People who have been disabled by sickness or injury can recover many of their original abilities and relearn activities of daily living many of their original abilities and relearn activities of daily living (ADLs) by seeking these services(ADLs) by seeking these services

Rehabilitation hospitals admit patients who are diagnosed with Rehabilitation hospitals admit patients who are diagnosed with trauma (e.g., car accident) or disease (e.g., stroke) and need to trauma (e.g., car accident) or disease (e.g., stroke) and need to learn how to function. learn how to function.


Rehabilitation Center (continued)Rehabilitation Center (continued)

Provide care for patients/ clients who require physical Provide care for patients/ clients who require physical therapy, (therapy, (hydrotherapy (hydrotherapy (treatments that use water treatments that use water therapy for disease or injury), and other therapies for therapy for disease or injury), and other therapies for loss of limb or organ function.loss of limb or organ function.


Rehabilitation Centers (continued)Rehabilitation Centers (continued)

They may receive They may receive prostheticsprosthetics (artificial part (artificial part made for the body) and learn how to use made for the body) and learn how to use adaptive devices.adaptive devices.


Rehabilitation Centers (continued)Rehabilitation Centers (continued)

Patients may stay in Patients may stay in these facilities or be these facilities or be treated on an treated on an outpatientoutpatient basis basis (patient does not (patient does not require hospitalization require hospitalization but is under a but is under a physician’s care.)physician’s care.)


Behavioural health care hospitalsBehavioural health care hospitals

22

specialize in treating individuals with mental health diagnoses.


Convalescent CareConvalescent Care

Generally care for elderly Generally care for elderly people who need nursing people who need nursing services and personal careservices and personal care

Examples: nursing homes Examples: nursing homes and long-term care facilitiesand long-term care facilities


Extended Care FacilityExtended Care Facility

This health care This health care facility functions as facility functions as a bridge between a bridge between hospital and home hospital and home when no longer when no longer acutely ill.acutely ill.


Ambulatory Care / ClinicsAmbulatory Care / Clinics

Facilities where severalphysicians with differentspecialties combine their

practices.

This allows the patient to have immediate

care for many differentillnesses


Physician and Dental FacilitiesPhysician and Dental Facilities

Provides care that promotes Provides care that promotes wellness and diagnosis of wellness and diagnosis of illnessillness

Services at most medical Services at most medical offices include examination, offices include examination, diagnosis, and treatmentsdiagnosis, and treatments

Simple surgery, bone setting, Simple surgery, bone setting, counseling, and administration counseling, and administration of drugs also take place here.of drugs also take place here.


2705/03/23 Dr.Mazen Maswady

Optical CenterOptical Center

If you are having If you are having vision problems, you vision problems, you need to visit an need to visit an optical centeroptical center


Health Maintenance Organizations Health Maintenance Organizations (HMO’s)(HMO’s)

Stress wellness (preventive Stress wellness (preventive health care) and focus on health care) and focus on keeping a person healthykeeping a person healthy

Provide health services that Provide health services that include hospitalization, basic include hospitalization, basic medical services, and medical services, and immunizationsimmunizations


HHome Health Care Agenciesome Health Care Agencies

Provide care in the Provide care in the home for patients home for patients who need health who need health services but not services but not hospitalizationhospitalization

Home health Home health workers provide care workers provide care for all agesfor all ages

Services include: Services include: nursing, physical nursing, physical therapy, personal care therapy, personal care (bathing, dressing, (bathing, dressing, etc.) and homemaking etc.) and homemaking (cleaning, food (cleaning, food shopping, and shopping, and preparation)preparation)


Senior Day CareSenior Day Care

Provides care for those Provides care for those elderly people who are able to elderly people who are able to live at home with their families live at home with their families but need care when the family but need care when the family is away.is away.

Provides a place where the Provides a place where the elderly can be cared for elderly can be cared for during the dayduring the day


Senior Day Care (continued)Senior Day Care (continued)

Provides activities, Provides activities, rehabilitation, and rehabilitation, and contact with other contact with other peoplepeople

The elderly are given The elderly are given their medications and their medications and are aided in mobilityare aided in mobility


World Health OrganizationWorld Health Organization

An international agency An international agency sponsored by the United Nationssponsored by the United Nations

Founded in 1948Founded in 1948 Concerned with world health Concerned with world health

problems and publishes health problems and publishes health information, compiles statistics, information, compiles statistics, and investigates serious health and investigates serious health problems worldwideproblems worldwide


Hospice careHospice care

This organization helps care for terminally ill patients (less This organization helps care for terminally ill patients (less than 6 months to live)than 6 months to live)

Most common diagnosis for these patients is cancerMost common diagnosis for these patients is cancer Philosophy is to help the terminally ill patient live each day Philosophy is to help the terminally ill patient live each day

to the fullest - usually at hometo the fullest - usually at home


Hospice (continued)Hospice (continued)

Patients are kept comfortable and free from painPatients are kept comfortable and free from pain Involves family. Families are counseled and helped in Involves family. Families are counseled and helped in

acceptance of the impending death of a loved one. After the acceptance of the impending death of a loved one. After the death, the family has continuing support for at death, the family has continuing support for at least a year.least a year.


Hospice (continued)Hospice (continued)

These facilities usually These facilities usually need to sponsor need to sponsor fundraising activities to fundraising activities to help with expenses. help with expenses.

No one is turned away No one is turned away due to financial reasons!due to financial reasons!


Government AgenciesGovernment Agencies

The federal, state, The federal, state, and local and local governments provide governments provide health services.health services.

These services are These services are funded by taxes!funded by taxes!


Veterans Administration HospitalVeterans Administration Hospital

These hospitals are federally supported and are These hospitals are federally supported and are known as government hospitals.known as government hospitals.

Provides care for veterans who served in the armed Provides care for veterans who served in the armed forcesforces

Ft. Bragg Arm Hospital is an example of a Ft. Bragg Arm Hospital is an example of a government hospitalgovernment hospital


US Public Health DepartmentUS Public Health Department

Is a federal agency that has 6 major Is a federal agency that has 6 major responsibilities:responsibilities:– Performing research for diseases that kill, handicap, or Performing research for diseases that kill, handicap, or

cripplecripple– Preventing & treating alcohol and drug abusePreventing & treating alcohol and drug abuse– Preventing and controlling diseases that are transmitted by Preventing and controlling diseases that are transmitted by

insects, animals, air, water, and people.insects, animals, air, water, and people.


US Public Health Department US Public Health Department (continued)(continued)

FDA (Federal Drug FDA (Federal Drug Administration - Checks Administration - Checks food and drugs that food and drugs that consumers purchase for consumers purchase for safetysafety

Planning more effective Planning more effective ways to deliver health ways to deliver health servicesservices

Making quality care Making quality care available and available and affordable by affordable by encouraging health encouraging health personal to work in personal to work in undeserved areas.undeserved areas.


The Public Health DepartmentThe Public Health Department

Provides services to local communitiesProvides services to local communities Responsible for reporting communicable diseases, Responsible for reporting communicable diseases, public public

health nursing, health nursing, health education, health education, environmental sanitation environmental sanitation ((methods used to keep the environment cleanmethods used to keep the environment clean


The Public Health Department The Public Health Department (continued)(continued)

Keeps records including Keeps records including immunization records, immunization records, health inspections, birth health inspections, birth records, and death records, and death statistics.statistics.

Also provides maternal and Also provides maternal and child health serviceschild health services


Nonprofit / Volunteer AgenciesNonprofit / Volunteer Agencies

Supported by donations, membership fees, Supported by donations, membership fees, fundraisers, and federal or state grants fundraisers, and federal or state grants

Provide health services at national, state, and local Provide health services at national, state, and local levelslevels

Most focus on specific diseases or health Most focus on specific diseases or health professionalsprofessionals

The Saudi Red Crescent and Saudi Medical The Saudi Red Crescent and Saudi Medical Associations are example of this type of agencyAssociations are example of this type of agency
