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Introduction To Healthcare and Public Health in The US

The Health IT Workforce Curriculum was developed for U.S. community colleges to enhance workforce training programmes in health information technology. The curriculum consist of 20 courses of 3 credits each. Each course includes instructor manuals, learning objectives, syllabi, video lectures with accompanying transcripts and slides, exercises, and assessments. The materials were authored by Columbia University, Duke University, Johns Hopkins University, Oregon Health & Science University, and University of Alabama at Birmingham. The project was funded by the U.S. Office of the National Coordinator for Health Information Technology. All of the course materials are available under a Creative Commons Attribution Noncommercial ShareAlike (CC BY NC SA) License. The course description, learning objectives, author information, and other details may be found at http://archive.org/details/HealthITWorkforce-Comp01Unit02. The full collection may be browsed at http://knowledge.amia.org/onc-ntdc or at http://www.merlot.org/merlot/viewPortfolio.htm?id=842513.

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43 views27 pages

Introduction To Healthcare and Public Health in The US

The Health IT Workforce Curriculum was developed for U.S. community colleges to enhance workforce training programmes in health information technology. The curriculum consist of 20 courses of 3 credits each. Each course includes instructor manuals, learning objectives, syllabi, video lectures with accompanying transcripts and slides, exercises, and assessments. The materials were authored by Columbia University, Duke University, Johns Hopkins University, Oregon Health & Science University, and University of Alabama at Birmingham. The project was funded by the U.S. Office of the National Coordinator for Health Information Technology. All of the course materials are available under a Creative Commons Attribution Noncommercial ShareAlike (CC BY NC SA) License. The course description, learning objectives, author information, and other details may be found at http://archive.org/details/HealthITWorkforce-Comp01Unit02. The full collection may be browsed at http://knowledge.amia.org/onc-ntdc or at http://www.merlot.org/merlot/viewPortfolio.htm?id=842513.

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Health IT Workforce Curriculum - 2012
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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You are on page 1/ 27

Introduction to Healthcare

and Public Health in the US


Delivering Healthcare (Part 1)
Lecture d
This material (Comp1_Unit2d) was developed by Oregon Health and Science University, funded by the Department of Health
and Human Services, Office of the National Coordinator for Health Information Technology under Award Number
IU24OC000015.
Delivering Healthcare (Part 1)
Learning Objectives
Describe the organization of healthcare at the
federal, state and local levels (Lecture a)
Describe the organization of the VA system and
Military Health System (Lecture b)
Describe the structure and function of hospital
clinical and administrative units (Lecture c)
Describe different types of long term care
facilities, with an emphasis on their function
(Lecture d)
2 Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Delivering Healthcare (part 1)
Lecture d
Delivering Healthcare (part 1)
Learning Objectives
Describe a variety of healthcare settings, with emphasis
on their function, including:
School-based health centers
Home healthcare
Group living
Assisted living, retirement communities, nursing homes
Hospice care (end-of-life care)
Long term, psychiatric, and specialty hospitals
Community mental health centers
Discuss important healthcare issues for older adults
Increasing need for assistance with daily activities
Financial, legal, ethical issues
3 Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Delivering Healthcare (part 1)
Lecture d
School-Based Health Centers
Children can and should receive physical and
behavioral healthcare in school
Providers are nurses, physicians, social workers,
substance abuse counselors, other providers
Further medical or hospital services are arranged as
needed
Parental consent is required
Healthcare may be periodic (for example, mobile
health center) or off-site (health center serving
more than one school)
4 Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Delivering Healthcare (part 1)
Lecture d
The Aging Population
1.5 Chart: (http://www.nia.nih.gov/ResearchInformation/ConferencesAndMeetings/WorkshopReport/Introduction.htm, ND)
5 Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Delivering Healthcare (part 1)
Lecture d
Difficulty with ADLs
(Activities of Daily Living) by Age
1.6 Chart: (http://www.aoa.gov/AoARoot/Aging_Statistics/Profile/2010/docs/2010profile.pdf , 2007)
6 Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Delivering Healthcare (part 1)
Lecture d
Percentage
of adults
Long term care Facilities
and Services
1.7 Chart: (http://www.medicare.gov/longtermcare/static/TypesOverview.asp, ND)
7 Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Delivering Healthcare (part 1)
Lecture d

Service or facility
Help with
ADLs
Help with other
services
Help with
care needs
Range of costs
Community-based services Yes Yes No Low to medium
Home healthcare Yes Yes Yes Low to high
In-law apartments Yes Yes Yes Low to high
Housing for aging and
disabled individuals
Yes Yes No Low to high
Board and care homes Yes Yes Yes Low to high
Assisted living Yes Yes Yes Medium to high
Continuing care retirement
communities
Yes Yes Yes High
Nursing homes Yes Yes Yes High
Financial and Quality Issues
Centers for Medicare and Medicaid Services (CMS)
Provides health insurance for older adults, disabled, poor
Covers 25% of US population; 94% of people age 65 or older
Reimburses qualifying healthcare facilities
Joint Commission (JC) certifies quality, safety
Independent nonprofit agency
Examines hospitals, nursing homes, home care organizations,
mental health programs, etc.
Healthcare facilities volunteer for JC certification
JC accreditation is a major factor in CMS approval for
reimbursement
8 Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Delivering Healthcare (part 1)
Lecture d
Home Healthcare
Home healthcare is assistance with ADLs and chores
inside the home
Family, friends, volunteers may help
Community services may be available
Skilled nursing is needed for medical issues
May be reimbursed by Medicare
Home healthcare agency is another option
Professional service
May be reimbursed by Medicare
Includes hospice care (end-of-life care)
9 Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Delivering Healthcare (part 1)
Lecture d
Board and Care Homes
(Group Homes)
Group living arrangements for people who
cannot live alone and need help with ADLs
Residents may have physical or mental disability,
cognitive impairment, substance abuse
Residents may be elderly, but not necessarily
Meals are provided, but medical care is not
Services, quality, and fees vary widely
May be paid in part by private insurance,
Medicare/Medicaid, other assistance
10 Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Delivering Healthcare (part 1)
Lecture d
Assisted Living
Person has own room or apartment in a large complex
Receives assistance with ADLs, 24-hour care
Offers group dining, social/recreational activities,
housekeeping/laundry
Medical services may be available on site
Service plan for each resident evolves over time
Facilities are licensed in most states
Billing is monthly rent plus fees for extra services
Insurance may cover some costs; Medicare does not
11 Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Delivering Healthcare (part 1)
Lecture d
Continuing Care
Retirement Communities
Offer different types of housing, depending on
the level of assistance needed
Separate homes/apartments for independent living
Assisted living facility for help with ADLs
Nursing home on site
May be accredited or not
Billing is a large entry fee plus monthly
payments
12 Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Delivering Healthcare (part 1)
Lecture d
Nursing Homes
Care for people who cannot live in home or community
May have medical, physical, mental problems
Facilities help with ADLs, provide nursing care
Some homes are hospital-like, others are home-like (for
example, have kitchen facilities and social activities)
Services include medical, nursing, personal care
A physician draws up a plan of care
Nursing care pertains to routine medications, acute conditions,
rehabilitation, special care units
Facility should be licensed/accredited, although
Medicare usually does not pay
13 Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Delivering Healthcare (part 1)
Lecture d
Other Long Term Care
Options for Older Adults
Community-based services
Various programs, coordinated by state agencies
State Medicaid may help with costs
In-law apartments
Defined as a separate living space on a property
Subject to local and state laws
Subsidized housing
Provide residence for older adults/disabled/poor, other services
Federal or state agency funds the program
Billing is a percentage of monthly income
14 Health IT Workforce Curriculum
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Introduction to Healthcare and Public Health in the US
Delivering Healthcare (part 1)
Lecture d
Hospice Care
Intended for patients with a terminal illness
Focus is palliative, or comfort care
Care is provided at home, dedicated hospice facility,
hospital, assisted living facility, or nursing home
Services may include medical/nursing care, medical
equipment, counseling, social services, help with
ADLs and housework, respite care
Home care workers should be licensed/bonded
Contact with family is an important focus
15 Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Delivering Healthcare (part 1)
Lecture d
Legal and Ethical Issues
Patients may/may not be able to make decisions
Family may not be available; patient may need legal
guardian
Patient has right to participate in important decisions
Long term care options
Informed consent
Informed refusal
Advance directives, living wills
Do-not-resuscitate order (DNR), termination of treatment
Power of attorney for healthcare
Long term care facilities have ethical/legal obligations
16 Health IT Workforce Curriculum
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Introduction to Healthcare and Public Health in the US
Delivering Healthcare (part 1)
Lecture d
Long Term Hospitals
Acute-care hospitals that provide prolonged care
(for more than 25 days)
Patients may have complex medical problems
May come from intensive care units
May have more than one condition
May need rehabilitation
Medicare covers hospital stay if hospital is
certified
17 Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Delivering Healthcare (part 1)
Lecture d
Specialty Hospitals, Rehabilitation
Care
Specialty hospitals focus on particular diseases or
medical fields
Common examples are cardiology, orthopedics, womens health,
and surgery
Less common example: end-stage kidney disease
Rehabilitation hospitals
Stand-alone hospitals or units within a hospital
Provide intensive daily rehabilitation
Outpatient rehabilitation is also available through
agencies, clinics
18 Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Delivering Healthcare (part 1)
Lecture d
Psychiatric Hospitals
Psychiatric care has evolved
Hospitalization is voluntary in most cases
Many types of care exist
Open units
Crisis stabilization units
Medium-term units
Juvenile wards
Long term care psychiatric hospitals
Some psychiatric hospitals specialize in certain
illnesses or addictions
19 Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Delivering Healthcare (part 1)
Lecture d
Day Hospitals
Provide mental health treatment during the day
Patient goes home at night
Considered an alternative to outpatient care
Distinct from hospitalization, residential treatment,
and day care
Patients are adults or children
Most facilities are hospitals or community centers
Provide individual/group therapy, other treatments
Goal is for patient to function within community
20 Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Delivering Healthcare (part 1)
Lecture d
Community Mental
Health Centers
Provide treatment for elderly, adults, or
children
Patients have chronic mental illness or recent
hospital discharge
Services include outpatient care, emergency
care, partial hospitalization, rehabilitation
May be reimbursed by Medicare
21 Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Delivering Healthcare (part 1)
Lecture d
Substance Abuse
Treatment Centers
Help patients overcome drug and/or alcohol
abuse
Various facilities
Residential treatment centers
Outpatient programs
Hospitals
Programs may specialize
By drug (for example, cocaine addiction)
By age group (for example, adolescents)
22 Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Delivering Healthcare (part 1)
Lecture d
Delivering Healthcare (Part 1)
Summary Lecture d
Multiple healthcare options exist for medical, mental
health, substance abuse, and end-of-life issues
Care location can be school, home, community,
hospital
Large variation exists in services, quality, costs
Facilities may or may not be licensed/certified
Services may or may not be reimbursed by
Medicare/Medicaid
Complex financial, legal, ethical issues apply
Need for elder care will only grow in the future
23 Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Delivering Healthcare (part 1)
Lecture d
Delivering Healthcare (Part 1)
Summary
Described the organization of healthcare at the
federal, state and local levels (Lecture a)
Described the organization of the VA system
and Military Health System (Lecture b)
Described the structure and function of hospital
clinical and administrative units (Lecture c)
Described different types of long term care
facilities, with an emphasis on their function
(Lecture d)
24 Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Delivering Healthcare (part 1)
Lecture d
Delivering Healthcare (part 1)
References Lecture d
References

Administration on Aging. A profile of older Americans: 2010.
http://www.aoa.gov/AoARoot/Aging_Statistics/Profile/2010/docs/2010profile.pdf. Accessed April 12, 2011.
American Health Care Association, National Center for Assisted Living. Consumer information about long term care.
http://www.longtermcareliving.com/assess/index.htm. Accessed April 11, 2011.
American Hospital Association. Long term acute care hospitals. http://www.aha.org/aha_app/issues/Medicare/Long-
Term-Care-Hospitals/index.jsp. Accessed April 11, 2011.
Centers for Medicare & Medicaid Services. https://www.cms.gov. Accessed April 11, 2011.
Commission on Accreditation of Rehabilitation Facilities International. Who we are.
http://www.carf.org/About/WhoWeAre. Accessed April 11, 2011.
Dubler NN. Legal and ethical issues. In: The Merck Manual of Geriatrics. Whitehouse Station, NJ: Merck & Co., Inc.;
2009-2010. http://www.merckmanuals.com/mm_geriatrics/sec1/ch14.htm. Accessed April 12, 2011.
Hospital.com. Choosing a long-term psychiatric hospital. http://www.hospital.com/psychiatry.html. Accessed April 11,
2011.
Medicare.gov. Types of long-term care. http://www.medicare.gov/longtermcare/static/TypesOverview.asp. Updated
March 25, 2009. Accessed April 11, 2011.
MedlinePlus. Health system. http://www.nlm.nih.gov/medlineplus/healthsystem.html. Updated May 21, 2010. Accessed
April 11, 2011.

25 Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Delivering Healthcare (part 1)
Lecture d
Delivering Healthcare (part 1)
References Lecture d (continued)
References (continued)

National Assembly on School-Based Health Care.
http://www.nasbhc.org/site/c.jsJPKWPFJrH/b.2554077/k.BEE7/Home.htm. Accessed April 11, 2011.
National Association for Home Care & Hospice. Basic statistics about home care.
http://www.nahc.org/facts/10HC_Stats.pdf. Updated 2010. Accessed April 11, 2011.
Office of Disability, Aging and Long-Term Care Policy. Licensed board and care homes: preliminary findings from the
1991 National Health Provider Inventory. http://aspe.hhs.gov/daltcp/reports/1993/rn06.htm. Published May 1993.
Accessed April 11, 2011.
Pace B. Hospice care. JAMA. 2006;295(6):712.
The Joint Commission. http://www.jointcommission.org. Accessed April 11, 2011.
U.S. General Accounting Office. Specialty hospitals: geographic location, services provided, and financial performance.
http://www.gao.gov/new.items/d04167.pdf. Published October 2003. Accessed April 11, 2011.
U.S. National Institutes of Health. National Institute on Aging. Workshop report.
http://www.nia.nih.gov/ResearchInformation/ConferencesAndMeetings/WorkshopReport/Introduction.htm. Updated
August 6, 2009. Accessed April 11, 2011.
Wiener JM, Hanley RJ, Clark R, Van Nostrand JF. Measuring the activities of daily living: comparisons across national
surveys. Office of Disability, Aging and Long-Term Care Policy. March 9, 1990.
http://aspe.hhs.gov/daltcp/reports/meacmpes.htm. Accessed April 11, 2011.

26 Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Delivering Healthcare (part 1)
Lecture d
Delivering Healthcare (part 1)
References Lecture d (continued)
Charts, Tables, Figures
1.5 Chart: The US Population Aging 65 years and Older from 1990 to 2050. From the US Census Bureauum, Population
Projections of the US by Age, Race, and Hispanic Origin: 1993 - 2050, pp 25-1104, 1993. Available from
http://www.nia.nih.gov/ResearchInformation/ConferencesAndMeetings/WorkshopReport/Introduction.htm
1.6 Chart: Bar chart depicting the percent of people with limitations in activities of daily living (ADL) by age group; 2007. Available
from http://www.aoa.gov/AoARoot/Aging_Statistics/Profile/2010/docs/2010profile.pdf
1.7 Chart: Available from http://www.medicare.gov/longtermcare/static/TypesOverview.asp



27 Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Delivering Healthcare (part 1)
Lecture d

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