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PHP 0310 (11)
Ira Wilson (11)
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PHP EXAM 1 NOTES

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Department
Public Health
Course
PHP 0310
Professor
Ira Wilson
Semester
Spring

Description
Php stuff to know Lecture1 (healthcare =23%) ­national expenditures growth rate slowing, but still growing ­more and more medicare/Medicaid spending ­less spending on hospital care (42.6­33.3), more on prescription drugs (5.1­10.6) ­less and less beds per 1000 ppl ­more hospitals in health systems ­inpatient days per 1000 ppl decreasing ­average length of stay decreasing ­hospitals = large employers ­hospital workers earning more and more ­number of hospitalizations and number of hospitals dropping ­mergers + integration of health systems to consolidate ­hospitals important to local economies ­supply of physicians keeping up with demand ­shortage of PRIMARY care specialists ­urban areas = oversupply, rural = undersupply; mal­distribution ­more female and older ­not enough minority physicians ­nurses getting older ­shortage of nurses ­lots of stress + burnout for nurses ­delivery system trends ­integrated delivery systems ­provider group consolidations ­physician hospital organizations (PHO) ­Accountable care organizations (ACO) ­shift to outpatient care from inpatient care ­lecture2 ­high cost, low quality system ­because more specialization than primary care ­primary care: provision of integrated, accessible healthcare by clinicians who  address a majority of health care needs and develop sustained relationship with patients,  practicing in the context of family and community ­integrated ­comprehensive services: any health problem at any stage of life ­coordinated: combination of services to meet patients’ needs ­continuous: care over time and timely communication of risks ­accessible ­ease of interaction btwn provider and patient ­efforts to eliminate geographical, financial, cultural barriers ­health care services ­refers to all care settings ­office, nursing facilities, nursing homes, hospitals, schools ­accountable ­provider responsible to patients for quality care, satisfaction, and  efficiency and ethicality  ­Primary care ­receive all problems ­able to manage most of them ­know when to refer to specialists ­personal healthcare  ▯social concerns related to personal function ­understands family, social dynamics ­culture, living conditions, etc. ­population is increasingly ­old, chronically ill, obese, diverse ­this kind of care (primary  ▯specialist) is what we need more ­secondary care ­short term, can be outpatient, technological focus ­tertiary care ­complex, institution based, highly specialized ­quarternary care ­pediatric heart surgery or BMT ­Primary care benefits ­prevention ­more likely to get prevention services like mammography etc. ­more satisfaction with personal relationship ­higher care quality ­lower care costs ­higher overall satisfaction ­who are primary care practioners? (pcp) ­family practitioners ­general internists ­geriatricians ­general pediatricians ­nurse practitioners ­physician assistants ­more consolidation in specialized than primary care ­More and more specialists lecture 3 ­primary care is in crisis; why? ­not adequate time for patients ­27% ppl did not have timely access to healthcare ­lots of ER visits NOT urgent; simply because no primary care ­few consistently visit primary care physician ­specialists more financially rewarded and exalted ­managed care pisses off primary care doctors ­more expectations  ­administrative issues ­specialists paid much more ­physician payment  ­know RUC  ­2010: Relative value * conversion factor (36.87 in 2010) ­Resource­based relative value scale update committee (RUC) ­run by AMA ­recommends relative value (RVU) for services ­conversion factor = update adjustment factor * medicare  economical index ­low quality results from not enough primary care ­who is going into primary care? ­more foreign ppl compared to internal ­only abt 20% of medical graduates going into primary care lecture 4 ­performance problems in primary care ­quality of work life issues ­multiple responsibilities, long work hours, stress/burnout, etc ­low pay relative to specialists ­not enough ppl going into primary care ­lifestyle, prestige, salary ­patient centered medical homes ­primary care associations ­joint = endorsed by 4 main physician groups in primary care ­personal physician ­patient has ongoing relationship w/ personal physician ­first contact, continuous, comprehensive care ­physician leads team of individuals that take care of patient ­completely responsible for all of patient’s healthcare needs ­care for ALL stages of life ­coordination/integration ­coordinated across all parts of healthcare system + patient  community ­leads to partnership btwn physician, patient, and patient family ­enhanced access  ­implement open scheduling, expanded hours, more  communication ­payment reforms ­pay for work/thought associated w/ 
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