...Evaluate biomedical model of health Current medical models assume that all illness is secondary to disease. Revision is needed to explain illnesses without disease and improve organisation of health care. Cultural and professional models of illness influence decisions on individual patients and delivery of health care. The biomedical model of illness, which has dominated health care for the past century, cannot fully explain many forms of illness. This failure stems partly from three assumptions: all illness has a single underlying cause, disease (pathology) is always the single cause, and removal or attenuation of the disease will result in a return to health. Currently, most models of illness assume a causal relation between disease and illness—the perceived condition of poor health felt by an individual. Cultural health beliefs and models of illness help determine the perceived importance of symptoms and the subsequent use of medical resources.4 The assumption that a specific disease underlies all illness has led to medicalisation of commonly experienced anomalous sensations and often disbelief of patients who present with illness without any demonstrable disease process. Finally, most biomedical models also seem strongly linked to primitive forms of intuitive mind-body dualism. Health commissioners, budgetary systems, healthcare professionals, and the public all act as if there is some clear, inescapable separation between physical and mental health problems, ignoring evidence...
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...The social model of disability What is the social model of disability, and why is it important to us? The social model of disability says that disability is caused by the way society is organised, rather than by a person’s impairment or difference. It looks at ways of removing barriers that restrict life choices for disabled people. When barriers are removed, disabled people can be independent and equal in society, with choice and control over their own lives. Disabled people developed the social model of disability because the traditional medical model did not explain their personal experience of disability or help to develop more inclusive ways of living. An impairment is defined as long-term limitation of a person’s physical, mental or sensory function. Changing attitudes to disabled people Barriers are not just physical. Attitudes found in society based on prejudice or stereotype, or disablism, also disable people from having equal opportunities to be part of society. Medical model of disability The social model of disability says that disability is caused by the way society is organised. The medical model of disability says people are disabled by their impairments or differences. Under the medical model, these impairments or differences should be 'fixed' or changed by medical and other treatments, even when the impairment or difference does not cause pain or illness. The medical model looks at what is 'wrong' with the person, not what the person needs. It...
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...Patient-Centered Health Care Home Many people in the United States do not have access to high quality primary care. There is substantial evidence indicating that sufficient access to high quality primary care results in lower overall health care costs and lower use of higher cost services, such as specialists, emergency rooms, and inpatient care. A large amount of the nation’s dollars are spent on health care. This large budget affects providers, patients, employers, and payers such as Medicaid, Medicare, and private insurers. This is a primary concern in many states including, Minnesota. There are significant gaps in the quality of health care that patients in the United States receive. The current health care payment and delivery system is particularly poor at providing care for people with chronic conditions. As a result of these factors, policy makers debated over proposals that can actually be effective. Some of these proposals aimed for reducing cost, focusing on patient, and improving quality of care. An example of a proposal that focused on patient-centered care and increased quality of care is the creation and introduction of Patient-Centered Health Care Home (PCHCH), also known as “Medical Home.” The introduction of the PCHCH in Minnesota will increase patients’ accessibility to health care services, give them power to be involved in decisions regarding their care, have continuity of care with their physicians, prevent duplication of services, reduce health care cost...
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...The term medical home has had quite the history! According to the PCPCC, Patient Centered Primary Care Collaborative, patient centered medical home is definitely not a new concept; even as far back as 1967, the American Academy of Pediatrics (AAP), actually introduced the term “medical home” (PCMH, 2015). Now, today’s term patient-centered medical home has evolved to define “a model of primary care excellence that is a patient-centered, comprehensive, coordinated, accessible, and committed to quality and safety” (PCMH, 2015). According to the government website, AHRQ, Agency for Healthcare Research and Qaulity, they define patient-centered medical home as a model which “holds promise as a way to improve health care in America by transforming how primary care is organized as well as delivered.” The AHRQ also states that the term medical home as not just a place, but also as a model of the “organization of primary care that delivers the core functions of primary health care” (PCPCC, 2016). When cultivating this type of medical home there are five functions and attributes that are involved: comprehensive care, patient centered, coordinated care, accessible services, and Quality and Safety (PCPCC, 2016). Overall, it comes down to this: the primary goal of the patient-centered medical home, according to the AHRQ, is to improve the quality as well as the outcome of care, which is what patient’s are looking for. The medical world seems to always be looking for ways to make health...
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...A majority of medical practices are lagging behind in face of the recent reforms in the United States healthcare sector. In fact, many people, both the medical professionals as well as their patients, can attest to feeling overwhelmed by these reforms and the inefficiencies they have brought about. Primary care is one of the biggest transformations currently taking place in healthcare. Helping to direct this transformation is a team of researchers lead by Dr. Edward H. Wagner, who have proposed a model for transforming primary care as well as improving efficiency and effectiveness in the health care system. This model, referred to as the Patient-Centered Medical Home (PCMH), embraces practice principles taken from the Chronic Care Model and the Pediatric Model (Wagner, 2012). PCMH model contains what is referred to as eight key “change concepts” that are essential for transforming a medical practice into a medical home. These change concepts are first introduced in the article “Guiding Transformation: How Medical Practices Can Become Patient-Centered Medical Homes” written by Edward H. Wagner, Katie Coleman, Robert J. Reid, Kathryn Phillips, and Jonathan R. Sugarman. Accordingly, I will be providing a critique of this article, as well as providing an assessment of the change concepts underlying PCMH. The article’s review of literature highlights the need for a robust primary care sector that can reduce health care costs and significantly improve care. In light of the Affordable...
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...Health Care Coordination Models: Benefits and Challenges Traci L French Salem International University Abstract: Care coordination refers to several forms of patient care management that is patient- rather than provider-focused and has the end goal of the “Triple Aim”-improved patient experience, improved population health and decreased per capita costs. These goals are achieved by developing healthcare models which promote collaborative care between providers, increase communication between health care entities, actively engage patients in health care and lifestyle choices and rely heavily on health technology to extend provider services, personalize care and monitor quality improvement efforts. The main barriers to care coordination implementation include poor reimbursement for services, difficulties with provider network communications, shortages of trained care coordination personnel and ambiguity in provider roles and responsibility, which can lead to provider accountability issues. When well-established, care coordination models allow patients to form substantive, long-term personal relationships with providers and increase personal accountability for health care choices. These relationships increase compliance with care regimens in the ambulatory setting and decrease costs with overall improvement in patient quality of life. Care coordination refers to several forms of patient care management which is patient- rather than provider-focused and has the end goal of...
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...plans outlines future medical services, therapies, rehabilitation, activities of daily living, equipment needs, home and job site modifications, appropriate education and residential programs, support care, and analysis of the disabled individual's return to work options. The need for individualism is necessary to meet the distinctive needs of each disabled person. The often-lengthy reintegration process and the need for various services over a long period have made comprehensive life care plans an important tool for the managing of severe disability. For years, rehabilitation professionals have outlined the medical services and therapies, training, job and residential...
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...The Neuman Systems Model applies a comprehensive and holistic approach to the care of patients based on the five variables. According to Parker and Smith (2010), the Neuman System Model is described as, “wellness orientation, client perception and motivation, and a dynamic systems perspective of energy and variable interaction with the environment to mitigate possible harm from internal and external stressors” (p. 183). The patient/ family are the client system and interrelate with the five variables namely; the physiological, psychological, sociocultural, developmental, and spiritual beliefs. The Neuman System Model has been used in diverse settings such as, in critical nursing, psychiatric nursing, gerontological nursing, and for teaching purposes. In the United States, “the model is used to guide practice with clients with acute and chronic health problems” (Parker &ump; Smith, 2010, p. 192). As further explained by Parker and Smith (2010), the client system is the core: a person, individual, or community and the core interact with the flexible lines of defense, the normal lines of defense, and the lines of resistance. The client system is constantly affected by internal and external stressors. The goal of nurses in applying the Neuman System Model is, “to maximizing the quality of life lived, maintaining the highest level of independence possible, and preventing exacerbations of the on-going illness” (Ebersole, Hess, Touhy, Jett, and Luggen, 2008, p. 258). Mrs. J is...
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...United States healthcare insurances are run by partly private and government institution ensuring individuals based on certain eligibility. Although the distinct system in the United States protrudes as one of the best health care providers around the globe, some individuals considered it as unmanageable catastrophic scheme. Additional information regarding United States health care system, the implications of its belief and values, and some models of health care delivery used in America are presented below. The health care delivery system of United States is a complicated organization involving education and research, medical suppliers, private, and government insurers, health care providers, payers, and the government. It composed an approximate number of 10 million in employment from doctors, nurses, dentists, pharmacists, administrators, caregivers, and more. The system also involves several institutions such as hospitals, nursing homes, mental health facilities, and clinical sites serving millions of people yearly. The medical services are usually compensated by private insurance, government insurance such as Medicare, Medicaid, SCHIP (State Children’s Health Insurance Program), and some private pay. The system comprises of functional and continual changing pattern in financing, insurance, delivery, and payment mechanisms representing an amalgam of government and private resources. Health care...
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...of health care. Andersen created a model that states predisposing factors, enabling, and need for medical treatment determine if a person will use the medical that is available to them. These factors are grouped into two categories, mutable and immutable. If a factor is considered immutable it cannot be changed. Mutable factors are generally unchangeable only on a temporary basis and can only be changed if effort is out fourth by the one in need. Additionally, Rosenstock and Becker’s health belief model reveals people will seek out medical care if they perceive themselves to be susceptible to health problems, believe their health problem is serious, believe treatment or prevention is cost effective and worth the time, and are able to seek out health care service (1995) influence one’s decision to utilize health care. In the case of John Q, he is a male who lives in a rural area. Although he works fulltime he is in the low income range and qualifies for government insurance through Medicaid. In this scenario, John suffers from high blood pressure and has a family history of poor heart conditions. While seeking a primary care physician John discovers the closest physician that accepts Medicaid is 40 minutes away. John relies on public transportation or carpooling with a friend to commute. With John’s family medical history of heart problems and his current situation of high blood pressure, he would be more inclined to seek regular medical wellness examinations to ensure his...
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...ACO is considered an organization of health care providers that agree to be accountable for the quality, cost, and overall care of Medicare beneficiaries who are enrolled in the traditional fee-for-service program. This paper identifies the differences between HMO’s and ACO’s but also correlates the similarities between ACO’s and Patient Center Medical Home (PCMH). The ACO’s place a degree of financial responsibility on the providers in hopes of improving care management and limiting unnecessary expenditures while continuing to provide patients freedom to select their medical services. The success and challenges of ACO are identified and explored. By increasing care coordination, ACO’s can help reduce unnecessary medical care and improve health outcomes, leading to a decrease in utilization of acute care services. “The term Accountable Care Organization (ACO) describes the development of partnerships between hospitals and physicians to coordinate and deliver efficient care” (Fisher, 2006). “Accountable Care Organization was first used by Elliot Fischer, Director of the Center for Health Policy Research at Dartmouth Medical School” (Deloitte, 2010). The ACO concept...
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...Evolving Practice of Nursing and Patient Care Delivery Models The Speech Hello, my fello nurses. Thank you for being here at the Summit of Nursing Evolution. My name is Chhay Yann-Ly and I am a nurse. We are living in an era where the United States (US) health care system is going through tremendous changes and challenges, with sky-rocketing health care costs, fragmented and poor quality of care, high volume of aging population, and passage of the Patient Protection and Affordable Care Act (PPACA) in 2010. A summary of the PPACA is basically to improve the health care delivery system, expand coverage, and control cost (Democratics Senate Gov/Reform, n. d.). With these changes, comes the evolutionary nursing professional transformation process. This speech is a crash course on the evolving practice of nursing and patient care delivery models. The goal of this speech is to discuss the continuity or continuum of care in relation to accountable care organizations, medical homes, and nurse-managed clinics health care models. Since nursing is the backbone of health care, all of these care delivery models require a robust nursing contribution for success (American Nurses Association (ANA), 2010). The first model is the accountable care organizations (ACO). ACOs is a “shared savings” with Medicare (part A & B). The ACO, according to the ANA (2010), is “a collaboration among primary care clinicians, a hospital, specialists and other health professionals who accept joint responsibility...
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... The practice of nursing is changing, growing, shifting in other words: transforming. Over the next decade, we will see nursing move from the acute care setting and into the community. I would like to discuss with you the concepts of accountable care organizations (ACO’s), medical homes, and nurse-managed health clinics, and continuum of care. Our health care system landscape is changing; no longer are we just treating illness, our health care system has evolved to one of disease prevention and wellness. With the signing of the Patient Protections and Affordable Care Act (PPACA), an additional 30 million Americans now have access to affordable and equitable health care (Institute of Medicine [IOM], 2011). The rising cost of health care and the sheer volume of those needing health care has led to reinventions in our care delivery models. According to the American Nurses Association (ANA), an ACO’s is a partnership between physicians, a hospital, specialists and additional health professionals who accept combined responsibility for the quality and fee of care delivered to its patients; if the ACO meets its earmarks for certain quality and savings targets, its participants get a monetary bonus. This model calls for nurses to work in partnership with physicians on coordinated care plans for...
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...Executive Summary Where would you want to live if you needed daily assistance during your golden years of life? In the comfort of your home, of course. Sandy’s Elder Care or (Assisted Living Facility) strives or (endeavors) to be that home for 4 full-time assisted living residents, offering medically-skilled care in a respectful, self-sustaining community. In our facility, residents will receive services from individuals with decades of experience in the medical and education fields as well as alternative visions of the potential in our elderly family members' latest years. In our first five years, we will establish a new kind of Elder Care model based on the idea that the elderly are fully-realized persons, with ideas, thoughts, and experiences which matter. Can you help us to realize this goal? 1.1 OBJECTIVES Financial: For our first year, we have four financial objectives: * To raise adequate funding for start-up. * To open the facility, and maintain it at 3 to 4 rooms occupied each month. * Begin development implementation for the ongoing funding needs of years two through five. Non-financial * To provide a warm, comfortable, safe and engaging home for up to 4 permanent residents. Ongoing feedback through the residents, family members of the residents and volunteers will give us a weekly update on our progress. * To provide adequate training, mentoring and compensation to our caregiving staff to create job satisfaction. 1.2 MISSION At...
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...Assignment 01: Reimbursement Models Grid |Accountable Care Organization (shared savings) |Primary Care Medical Home |Bundled Payment |Partial Capitation |Full Capitation | |Strengths and Weaknesses |-Providers are accountable for total per-capita costs. -Patient “lock-in” is not required. - Reinforced by other reforms that promote coordinated, lower-cost care. |-Supports coordination of care between physicians. -Does not require accountability for total per capita cost |-Promotes efficiency and care coordination. -Does not require accountability for total per capita cost |- Combines FFS and prospective fixed payment, providing “upfront” payments that can be used to improve infrastructure and process. - Accountability only for services/providers. - May be viewed as risky by many providers. |- Provides “upfront” payments for infrastructure and process improvement and makes providers accountable for per-capita costs. - Requires patient “lock-in.” - May be viewed as risky by many providers. | |Strengths for Primary Care |YES - Provides incentive to focus on disease management. - Additional support by adding medical home or partial capitation payments to primary care physicians. |YES – Changes care delivery model for primary care physicians, allowing for better care coordination and disease management |YES, indirectly – Bundled payments result in greater support for primary care physicians |Yes – Partial Capitation allows for infrastructure and process improvement...
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