Patient Information and Confidentiality Essay

Patient Information and Confidentiality

Order Instructions:

For this module, explain the threats to patient information and confidentiality that are present in your selected organization (Salisbury,NC VA). Be sure to link them with regulations (e.g., HIPAA and Wi-Fi security).

Module Overview

Concerns over the privacy and security of electronic health information fall into two general categories: (1) concerns about inappropriate releases of information from individual organizations and (2) concerns about the systemic flows of information throughout the healthcare industry and related industries. Inappropriate releases from organizations can result either from authorized users who intentionally or unintentionally access or disseminate information in violation of organizational policy or from outsiders who break into an organization’s computer system. The second category, systemic concerns, refers to the open disclosure of patient-identifiable health information to parties that may act against the interests of the specific patient or may otherwise be perceived as invading a patient’s privacy. These concerns arise from the many flows of data across the healthcare system, between and among providers, payers, and secondary users, with or without the patient’s knowledge. These two categories of concerns are conceptually quite different and require different interventions or countermeasures.

Presentations and Required Readings
https://www.salisbury.va.gov/
•The following is primary reading required for this module: Privacy and Security Concerns 1
•This article discusses the primary goals of information security in healthcare and examines policy and appropriate uses of medical data: Confidentiality of Electronic Medical Records 2
•Zachary Wilson offers a good explanation of the difference between internal and external sources of attacks. Additionally, he illustrates a wide range of vulnerabilities and how they can be exploited. (Do not get hung up in the technical concepts and jargon at this point. We will cover the more technical aspects later in this course.) Vulnerabilities and attacks3
•The following provides a brief overview of basic concepts surrounding information security along with an introduction to vulnerabilities, controls and policies: Security Concepts4
•Read Chapter 4 “Privacy and Confidentiality” from the following book that is available through the eBrary resource, which can be accessed from the TUI CyberLibrary:
?Anderson, J. G. (2002). Ethics and Information Technology : A Case-Based Approach to a Health Care System in Transition. Springer-Verlag New York, Incorporated, Secaucus: NJ. 63-112. Retrieved on September 8, 2007, from the eBrary database.5
•The following is the United States Department of Human Services summary version of the HIPAA Privacy Rule. HIPAA Privacy Rule6
•Wi-Fi Security concerns7

Sources for Presentation Material Referenced Above

For the Record: Protecting Electronic Health Information (1997). Committee on Maintaining Privacy and Security in Health Care Applications of the National Information Infrastructure Protecting Electronic Health Information. Washington, DC, USA: National Academies Press. 54-81. Retrieved from the eBrary database.

Barrows, R. C., and Clayton, P. D. (1996). Privacy, Confidentiality, and Electronic Medical Records. Journal of the American Medical Health Informatics Association, 3 (2), 139-148. Retrieved from the PubMed Central database.

Wilson, Z. (2001). Hacking: The Basics. SANS Institute. Retrieved from http://www.sans.org/reading_room/whitepapers/hackers/

Quinsey, C. and Brandt, M. (2003). AHIMA Practice Brief: Information Security: An Overview. American Health Information Management Association. Retrieved from http://www.advancedmedrec.com/images/InformationSecurityAnOverview.pdf

Anderson, J. G. (2002). Ethics and Information Technology : A Case-Based Approach to a Health Care System in Transition. Springer-Verlag New York, Incorporated, Secaucus: NJ. 63-112. Retrieved from the eBrary database.

Summary of the Privacy Rules. (2003). U.S. Department of Health and Human Services. Retrieved from http://www.hhs.gov/ocr/privacy/hipaa/understanding/summary/

Alam AS, Al Sabah SAA, Chowdhury AR (2007). Wi-Fi Security The Great Challenge. National Conference on Communication and Information Systems. National Conference on Communication and Information Security.

SAMPLE ANSWER

Patient Information and Confidentiality

Concerns over security and privacy of the electronic health information may be in relation to releasing information inappropriately from an individual organization or the systematic information flows in a healthcare industry as well as the related industries. Information leaks from an organization when unauthorized users purposefully or unintentionally disseminate or access information against the organizational policy. Outsiders could also break into the computer systems. There are also cases where the professionals act against the interests of particular patients, therefore invading the privacy (Anderson, 2002). Data or information is normally exchanged between different professionals, and these concerns could arise in between, either among the secondary users, payers, and providers, either without or with information about the patient. Therefore, countermeasures and interventions are necessary. The aim of this paper is discussing the threats to patient confidentiality and information present in Salisbury,NC VA, with reference to regulations like Wi-Fi security and HIPAA.

Based on HIPAA, security provisions and data privacy is provided to medical information. The regulation guarantees proper protection of health information and at the same time, permitting easy and efficient health information flow for high quality care to be provided. This also helps in protecting the wellbeing and health of the public. There is a particular way in which the healthcare professionals are required to handle all the patient information they come across. The regulation requires that covered entities should have the appropriate physical, technical, and administrative safeguards for guarding the privacy of non-electronic and electronic protected health information (Barrows & Clayton, 1996).

HIPAA offers protections on the insurance information. From the institution’s website, there is a section on insurance and billing. If someone is really interested in the information, he or she can easily hack to acquire it. The link on patient information also has a lot that can be stolen. Therefore, there is a need to the hospital to be cautious about leaking information as this can easily tarnish the reputation and image, therefore, leading to patient turnover.

From the website, the phone directory provides information about the service, location, and phone for the various patient advocates. This is very risky since someone outside the healthcare institution might call asking for information of a particular patient or staff, or even go to the physical addresses provided (Barrows & Clayton, 1996). Unknowingly, a professional might provide the sensitive information to an outsider, after which it can be used in inappropriate activities.

Data protection has become very pertinent in the modern day technology world. Public WiFi providers should be informed about their obligations as far as the Data Protection Act (1998) is concerned, particularly in relation to the collection and processing of personal information. Salisbury, NC VA is posing immense threats to patient confidentiality and information. A quick scan at the institution’s website makes it evident that the personal information belonging to patients can easily be interfered with. The information might even be stolen and used for malicious activities. Regardless of the fact that the information might need to be used by different healthcare professionals for promoting high quality healthcare, there should be more controls where the external people should not be able to view the data as is the case.

When using internet at the institution, there should be controls, where the guest WiFi can be separated from the business WiFi (Alam, Al Sabah Chowdhury, 2007). This can go a long way in preventing compromises on the sensitive patient information. The hospital should take charge of its information technology privacy and confidentiality, and ensure that the EPOS systems and private networks are protected. WiFi and other forms of internet are normally used at the institution, and considering how delicate the exchange of information and data among and between the professionals has become, the necessary measures need to be taken.

Having noted that there is intensive internet use at the institution, there is a great need to emphasize that in case Wi-Fi passwords are normally offered to the customers or even patients for internet access, then the management should remain informed that this is actually a big risk to the business. This is the reason why there should be a secure and separate system for the guests. A good solution to this can be ensuring that the network is protected, and a secure login can be used (Barrows & Clayton, 1996).

Conclusion

From the foregoing discussion, it has been that patient confidentiality and privacy have been compromised to a great extent. This clearly relates to the storage and exchange of personal and sensitive patient information online or through the various social media platforms. As such, it can be very easy for the outsiders or even people within to exchange and share the information either intentionally or unintentionally. Consequently, the information and reputation of the institution would be compromised. However, there are regulations such as HIPAA and Wi-Fi which offer guidance on what institutions such as Salisbury, NC VA need to do so as to protect the information their patients offer.

References

Alam, A. S., Al Sabah, S.A.A., Chowdhury, A.R. (2007). Wi-Fi Security The Great Challenge. National Conference on Communication and Information Systems. National Conference on Communication and Information Security.

Anderson, J. G. (2002). Ethics and Information Technology : A Case-Based Approach to a Health Care System in Transition. Springer-Verlag New York, Incorporated, Secaucus: NJ. 63-112. Retrieved from the eBrary database.

Barrows, R. C., & Clayton, P. D. (1996). Privacy, Confidentiality, and Electronic Medical Records. Journal of the American Medical Health Informatics Association, 3 (2), 139-148. Retrieved from the PubMed Central database.

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Privacy and security in electronic health services

Order Instructions:

Case Assignment

For your Module 4 Case Assignment, in 2-3 pages, answer each of the “questions for discussion” listed below each case. Develop your answers in 150 to 250 words for each question within the context of the background material. In addition, incorporate relevant applicable laws.

Section 1:

Explain the characteristics of technical, physical, and organizational privacy and security concerns.

Section 2: Case 4.8: E-Mail Goes Astray

Kaiser Permanente, one of the nation’s largest health insurers with 8.5 million subscribers, accidentally compromised the confidentiality of the medical information of 858 of its members. The problem occurred when a technician began sending out a large number of e-mail messages that had been backlogged while Kaiser’s system was being upgraded. Some e-mail messages were sent to the wrong recipients. Members access the website and use the e-mail system to fill prescriptions, make appointments, and seek medical advice. Some of the messages contained names, home telephone numbers, medical account numbers, and medical advice. When the technician noticed the problem, he stopped sending out e-mails but did not notify Kaiser managers of the problem. The next morning, two Kaiser subscribers notified the company that they had received other subscribers’ e-mails. The following message appears on the website:

“Your information is confidential. We are dedicated to keeping your personal health information confidential. We take many precautions to make sure others can’t pretend to be you and get your confidential information from the Web site. As long as you don’t give out your PIN, any confidential information you send or receive on this Web site can be seen only by you and Kaiser Permanente staff who have a ‘genuine business need.’ ” The director of Kaiser’s Web site indicated that once the error was discovered, Kaiser officials attempted to telephone each of the subscribers whose e-mails had been sent to the wrong person and, “We have fixed the problem.”

Source: Brubaker B. ‘Sensitive’ Kaiser e-mails go astray. The Washington Post. August 10, 2000: E01.

Questions for Discussion:
1.Who is responsible for the breach in confidentiality? The technician? Kaiser Permanente? And why?
2.Will this breach of confidentiality discourage subscribers from accessing the Kaiser Web site to fill prescriptions and seek medical advice? How can subscribers be reassured that their information will be kept confidential in the future?

Case 4.7: Patients’ Files Used for Obscene Calls

An orthopedic technician who had been convicted of child rape and indecent assault used the password of a former hospital administrator to gain access to confidential medical records of 954 patients at a major hospital. He then made obscene telephone calls to female patients as young as 8 or 9 years old.

The technician’s access to the confidential patient records began in December and continued until he was fired four months later. The hospital was not aware of the problem until a trace on the telephone line of a girl who was receiving obscene calls indicated that the calls originated from the hospital. The computer system failed to detect the outdated password and did not alert employees who were responsible for maintaining the information system that one individual was accessing a large number of patient files. Moreover, the hospital did not conduct background checks when hiring new employees.

Source: Brelis M. Patients’ files allegedly used for obscene calls. The Boston Globe. April 11, 1995: 1.

Questions for Discussion:
1.Should healthcare institutions conduct background checks on new employees who will be allowed access to confidential patient information? What information should be accessible to such employees?
2.How could the hospital have prevented the misuse of patient information from occurring? Was the hospital’s security system at fault for this breach of security?
3.Should the hospital be held accountable for the actions of the technician?

Case 4.44: University Tightens Computer Security

A university is tightening its computer security after hackers broke into a computer at the medical school and secretly used it to generate a flood of e-mail advertisements. Efforts by the university to cope with the break-in have caused balky and intermittent e-mail service for seven months for hundreds of staff members. At least once, e-mail service throughout the system shut down for two days. University officials did not detect the break-in until at least a couple of weeks later, when someone forwarded an advertisement sent by the computer.

A university spokesperson said that no file information was improperly accessed. Instead the hackers merely used the system to generate e-mail promoting other websites. The university announced that $150,000 would be spent to install new equipment to restore the e-mail system. A number of security measures were being upgraded to prevent the computer system from being broken into in the future.

Source: Birch D. Hopkins tightens computer security. The Baltimore Sun. May 29, 1999: 1B-2B.

Questions for Discussion:
1.Are university medical center information systems especially vulnerable to hackers? Why, or why not?
2.Is the medical center accountable for any harm that is caused by unauthorized entry into patient records?

Module Overview

Presentations and Required Readings
•The following is primary reading required for this module: Privacy and Security Concerns1
•This article discusses the primary goals of information security in healthcare and examines policy and appropriate uses of medical data: Confidentiality of Electronic Medical Records2
•Zachary Wilson offers a good explanation of the difference between internal and external sources of attacks. Additionally, he illustrates a wide range of vulnerabilities and how they can be exploited. (Do not get hung up in the technical concepts and jargon at this point. We will cover the more technical aspects later in this course.) Vulnerabilities and attacks3
•The following provides a brief overview of basic concepts surrounding information security along with an introduction to vulnerabilities, controls and policies: Security Concepts4
•Read Chapter 4 “Privacy and Confidentiality” from the following book that is available through the eBrary resource, which can be accessed from the TUI CyberLibrary:
?Anderson, J. G. (2002). Ethics and Information Technology : A Case-Based Approach to a Health Care System in Transition. Springer-Verlag New York, Incorporated, Secaucus: NJ. 63-112. Retrieved on September 8, 2007, from the eBrary database.5
•The following is the United States Department of Human Services summary version of the HIPAA Privacy Rule. HIPAA Privacy Rule6
•Wi-Fi Security concerns7

Sources for Presentation Material Referenced Above

Wilson, Z. (2001). Hacking: The Basics. SANS Institute. Retrieved from http://www.sans.org/reading_room/whitepapers/hackers/

Summary of the Privacy Rules. (2003). U.S. Department of Health and Human Services. Retrieved from http://www.hhs.gov/ocr/privacy/hipaa/understanding/summary/

SAMPLE ANSWER

Section 1

The physical, technical, and organizational privacy and security concerns are categorized into two main forms; concerns about the flow of information systematically within the whole healthcare industry and concerns over the inappropriate release of information within an organization. This may arise when some individuals are given access to some confidential information hence violating a company’s privacy policy (Kshetri, 2013). The systemic concern, on the other hand, is the release of particular patient identifiable information about their health that may be against their wishes hence presenting a major invasion of patient privacy.

The concerns hold different characteristics. For example, there is organizational threats which involve vulnerability of individual organization electronic health records to external or internal agents. Internal agents are those with authorization and have access to information yet they abuse their privileges.

Conversely, external agencies do not have access to the information, yet they try to manipulate the data or rendering the system unusable. Another characteristic includes the concerns that may arise due to sensitive information that could easily be used against the patients as a means of acquiring a leverage over them (Boric-Lubecke et al., 2014). The information mostly targeted are those of celebrities, employers, politicians, and journalists.

The basic approach to countering threats to privacy in healthcare is erecting policies against the act of violation and setting heavy fines against anyone who violates privacy rules. Organizations should also have continuous checkup of their system’s accessibility and employ trustworthy workers to man the system.

Section 2

Case 4.8: Emails Goes Astray

Question 1

The technician was in charge of the breach. The act of not checking the backlogged information before confirming who the email was sent to, suggests so. The other reason was the number of emails sent before realizing the mistake; the medical information of 858 of its members had compromised which is a high volume. Also, instead of reporting the problem to the superiors, the technician left the insurance company to deal with the mistake he had committed. Kaiser Permanente was not responsible for the breach as they even tried to correct and put the subscribers at ease as they handled their information. Under HIPAA privacy rule, the responsibility of health insurers and organizations is to be accountable to the disclosure of their patients and confidential communication. Therefore, Kaiser Permanente did the right thing of informing its subscribers about the technical challenges on the website. They also emphasized on the pretenders warning them in the case of such an issue.

Question 2

The breach will discourage subscribers from the Kaiser web due to reduced trust in confidentiality of the organization. People tend to learn or fear from others mistakes. The subscribers can be reassured by integrating a better system that requires constant change of passwords thus narrowing the margin of email being hacked and informing them. This also ensures that the company adjusts well to the need of the subscribers. Notifying them that they are securing the site for them will make them feel assured and valued. This goes hand in hand with reassuring them that their information is safe. Employing better technicians, to prevent incompetence at work and informing subscribers of the root of the problem after an investigation is essential as it informs the subscribers that the case was not completely forgotten and they are involved in the processes taking place in the organization.

Case 4.7: Patients Files Used for Obscene Calls

Question 1

Clinical centers should carry out background checks on all new employees before allowing access and employ them. It should be carried out by searching through their public records, private investigations, checking their websites and face to face interviews that requires a detailed history of all previous endeavors and checking if it all fits public record (Yüksel, Küpçü & Özkasap, 2017). The main benefits include increased in value of hire, prevents shame of employing criminals, ensures regulatory acquiescence; satisfies industrial standards, reduces chances of drug abuse and less absenteeism and improves workplace safety and security. Information that should be accessible to such employees should be petite. The technician should only be given access to names of patients and medical records under supervision. Allowing such minimal ensures that they do not get the personal information that can be used to irritate patients. The medical files would be required to conduct his work.

Question 2

There are multiple ways of preventing such a breach. The hospital could have performed a full background check on the technician which could have reduced the risk employing an incompetent individual. In the case study, the hospital had employed the technician yet he was previously convicted of indecent assault and child rape. The hospital should have regularly updated the accessibility passwords. The incident in the case study was due to a failure of updating password allowing for the access of the orthopedic technician even after he was fired. The hospital should have to conduct more frequent vulnerability assessments tests; monthly or every two months. Updating the software systems would also have prevented failure on alerting the people in charge of maintaining information systems. The hospital security system was responsible for the breach as it failed to inform the employees in charge of maintaining information systems.

Question 3

For the technician’s actions, the hospital should be held liable. The hospital was responsible for the employment of a rape offender and indecent assault, to begin with; they did not conduct background checks while hiring new employees. The security system of the hospital allowed the technician access even after he was fired. During his time as a technician, supervision was not provided giving him freedom of action. The hospital also granted access to personal confidential information to a technician, yet receptions and secretaries are the people supposed to possess such information. The hospital was not aware till the girl’s obscene calls were traced inside the hospital. The hospital information system, including employees, were incompetent as this could have been noted at early stages but it got to four months.

Case 4.44 University Tightens Computer Security

Question 1

The University Medical Center Information Systems are not vulnerable to hackers. As from the context the hacker who secretly used them to obtain a flood of e-mail for just advertisement purpose suggests that he or she was not interested in the medical information or records within the system. No information is recorded to be missing as reported by the spokesman. The main aim was to create flood email, and any of the superior computer systems would also have been an easy target. Hackers use an external server to avoid detection while sending emails or viruses like Trojan to render a given site useless. They look for the easy access mainframes to operate; in this case, the medical school computers were previously not as well protected the efforts done after the hack. To restore email system they spent $150,000 installation of new equipment and numbers of security measures were upgraded in the process.

Question 2

The health center is responsible for any harm that happens on patient health records. The spokesperson touched on the issue of improper access of information saying that none was obtained. This shows that the medical center should beef up the security of the information and prevent similar hacking cases from occurring in future. Medical centers are bound by Health Insurance Portability and Accountability Act, (HIPAA) rules to prevent disclosure privacy and security of the patients’ information, confidential communication. HIPAA privacy rule safeguards all identifiable health information of patients that is relayed by a covered entity or business associate. The university had the right of protecting its clients’ information against any hackers with the intention of violating the rules of privacy, as per HIPAA, within the medical center. Therefore, expenses on the installations were put across as well as an upgrade and prevent future hacking incidents.

References

Boric-Lubecke, O., Gao, X., Yavari, E., Baboli, M., Singh, A., & Lubecke, V. M. (2014, June). E-healthcare: Remote monitoring, privacy, and security. In Microwave Symposium (IMS), 2014 IEEE MTT-S International (pp. 1-3). IEEE.

Kshetri, N. (2013). Privacy and security issues in cloud computing: The role of institutions and institutional evolution. Telecommunications Policy, 37(4), 372-386.

Yüksel, B., Küpçü, A., & Özkasap, Ö. (2017). Research issues for privacy and security of electronic health services. Future Generation Computer Systems, 68, 1-13.

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Recovery Principles & Clinical Recovery; Mental Health

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SAMPLE ANSWER

Mental Health: Recovery Principles & Clinical Recovery

Introduction

The concept of recovery oriented practice has increasingly become a prominent concept in mental health policy internationally. This notion originated from consumer perspectives that challenged traditional beliefs about course of mental health disorders and the effective treatment strategies, and it has become widely conceptualized that recovery oriented care is a deeply unique process that changes a person’s attitudes, feelings, values, goals and skills with the aim of improving life limitations caused by the mental illness (Doran et al., 2015). Using Janet’s case study Version 1 and Version 2, this essay expounds on the concept of recovery oriented care by focusing on recovery principles; and elaborating how recovery principles differ from clinical principles.

Recovery principles

Recovery principles refer to the collective approach used to respond to the mental health distress by supporting empowerment, autonomy and retention of hope. Fundamentally, the recovery principles focus on the benefit of acknowledging a person as a whole instead of defining them by their deficits or difficulties (Evans et al., 2017). In this context, recovery is supported through the implementation of collaborative and consultative treatment strategies to people with mental health issues. These strategies place the client at the center of care and emphasize on individuals strengths to support their self determination. The recovery principles are core to the professional standards for Australian and New Zealand mental health includes uniqueness of an individual, autonomy, rights and attitude of their carers, treating mentally ill people with dignity and respect, collaborative care enhanced through effective communication (Mental Health Commission, 2012).

Based on recovery principles, helping patients who experience mental health issues with psychotic clinical issues, such as bipolar disorder and schizophrenia, requires a range of skills and attitudes that are developed from sound knowledge foundation as well as inquisitive approach. The core recovery principle in this group of attributes is the ability to establish a respectful support and collaborative relationship (therapeutic alliance) with the client, their relatives, friends and their loved ones (Slade et al., 2014).

The main challenge for clinical practice during the recovery paradigm is the capacity to remain responsive to the patient’s change and family/loved ones concerns. However, this is vital because client’s capacity to exercise autonomy during decision making may fluctuate over time. For instance, the client may change their desired treatment approach frequently or the client’s family may hold different opinions about the best treatment. Therefore, the recovery principles enable the provider to develop the capacity to ‘be with’ instead of insisting on the standard clinical practice. For instance, in Janet’s Case study Version 2, “the psychiatrist was happy to reduce drugs after 10 days when Janet told her how horrible they were” (O’Hagan, 2014, p.227).

From this analysis, the healthcare provider should understand their own feelings and values to this practice. This is because their personal ethical beliefs and values could make them to inadvertently exhibit judgmental behaviors which could compromise care. The mental health care providers should perform rigorous and regular clinical supervision so as to retain clarity in nursing practice (Evans, Nizette, & O’Brien, 2017). Clinical supervision is one of the recovery principle recognized as professional standard for Australian as well and New Zealand mental health nurses. In addition, it is evident that recovery principles are based on reflective care that is not influenced by the individual’s personal values or ethics. These principles emphasize on self determination and collaborative partnership. For instance, in Janet’s case study version 2,Through collaborative treatment approaches, Janet was able to overcome the sexual abuse trauma; she is better, and now works as a mental health nurse, where she uses her experience to guide other mentally ill patient (O’Hagan, 2017, p.228).

The difference between recovery principles and clinical recovery

Recovery can be viewed through different lenses – personal experience (set of workforce competencies/practices) or clinical recovery process. This personal recovery approach is viewed as the post institutional service philosophy because it challenges the bedrock of traditional mental health system (Barder, 2012). Clinical recovery is a concept that emerged from the expertise of mental health care providers, and it entails treating of psychosocial symptoms so as to restore functioning or to bring back the patient’s life back to normal. Recovery principle differs in clinical recovery in that the concept emerged from expertise of people who have lived the experienced or mental illness (Hapell et al., 2013). On the other hand, recovery principle dwells on a deep unique change of a person’s values, attitudes and feelings with the aim of living a satisfactory life within the daily life limitations associated with the illness. It is basically creating a new purpose and meaning in client’s life as she or he grows beyond the catastrophic event associated with the mental illness (Williams et al., 2012).

As depicted in Janet case study Version 1, the traditional healthcare system perceives mental illness with no legitimacy. Most clients experience major mental health issues as frightening, desolate and also destructive. This is because the pain in mentally ill clients is at par with grief and torture of surviving a battle field or that of being accused of heinous crime (Leah, 2012). The only difference is that the latter experiences have legitimacy and the society has a well defined pathway for their justice and recovery; and surviving them is perceived as heroic and is admirable. On the other hand, mental health is met with fear, reproach and pity. Unlike clinical recovery, recovery principles recognize the importance of person recovery in that mental illness is perceived as a full human experience; therefore, it does not support justification for segregation, cruelty and coercion. A society that has person recovery mind concepts has place for people with mental health illness because seeks to provide a better pathway to better life (O’Hagan, 2014).

Another aspect of clinical recovery that acts as bedrock of the unfortunate traditional belief is community’s abdication of responsibility for the mentally ill people to the profession and services. In the current society, people seek answers to human problems from state- authorized profession institutions. Although to some extent this has been of benefit, it is associated with overdependence of deficit oriented institutions and professionals. Their reputed monopoly on expertise has disabled the mentally ill clients by keeping the stuck in the healthcare services as indicated by Janet’s case study version 1, “the mental health system is responsible for the Janet’s terrible state (O’Hagan, 2014, p. 224).

The devaluation of mental illness in conjunction with community abdication has is associated with naïve community consensus around client’s safety, which is based on discriminative assumption that mentally ill people are not responsible of their behavior, and that the mental health institutions and services must take responsibility of their behavior through tightly controlled approaches (Gilburt et al., 2013). The clinical recovery approach develops unsustainable assumptions that mentally ill persons must be controlled like robots; they lack freewill and those mental health institutions and professionals have magical powers to predict and that the strict measures towards the mentally ill people is meant to establish a safer community. Unfortunately, the unrealistic demands have led to increase in risk adverse practices such as liberty restrictions, locked doors and compulsory treatment just as those experienced by Janet Version 1 case study (Berglund, 2012; Ivey et al., 2012).

Clinical recovery is important, but focusing on clinical recovery alone makes the patient to feel defined by their mental health problem, thereby exacerbating the problem. This approach also makes a person to neglect other aspects of lives that could be cultivated and potentially lead to improved wellbeing (Evans & Brown, 2012). Most of the clinicians identify mental illness experiences such as hearing voices a focus of clinical recovery, which not only make it problematic, but also leads to waste or resources in order to get rid of personal idiosyncrasies that otherwise would be the patient’s assets if well understood and work with using the best approaches possible. On the contrary, the recovery principles of the mental health service seek to design treatment strategies for mental illness is that does not only keeping people out of acute crisis so that they can lessen their dependency and burden to the community. The strategies contemplate the possibility of holistic recovery instead of focusing on clinical issues only, which in most cases could be resolved (Le Boutillier et al., 2015).

Conclusion

Mentally ill people are human beings too; they have rights as other citizens and must be allowed to participate in their local communities. To ensure that the mentally ill patients are socially included in the community’s daily life, the society and mental health professions will be required to change their traditional beliefs and unfortunate assumptions about mental health. In this context, the final frontier is eradicating the barriers that prevent people from experiencing their entitlements as the other citizens. This involves transformation of “treat clinical symptoms- and recover” world view. In addition, the mental health systems should give priorities to treatments strategies that help the mentally ill patient to continue re-engaging with their life. However, the most important and the broadest challenge is the societal change. This implies that the mental health professionals should collaborate with people with lived experienced of mental illness to become partners and social activists who challenge the erroneous stigmatizing assumptions associated with mentally ill people which prohibits them from enjoying the same citizenship entitlements as other people in the community.

References

Barder, M.E.(2012). Recovery as the new medical model for psychiatry. Psychiatr Serv 63 (3) 277-279

Berglund, C. A. (2012). Enter the patient. In C. A. Berglund (Ed.), Ethics for health care (4th ed.) (pp.71-97). South Melbourne, Vic: Oxford University Press

Doran, E., Fleming, J., Jordens, C., Stewart, C. L., Letts, J., & Kerridge, I. H. (2015). Managing ethical issues in patient care and the need for clinical ethics support. Australian Health Review, 39(1), 44-50. doi: 10.1071/AH14034

Evans, K., Nizette, D. & O’Brien, A. (2017). Psychiatric and mental health nursing (4th ed.). Chatswood, NSW: Elsevier Australia.

Edwards, K-L., Munro, I., Welch, A. & Robins, A. (2014) Mental Health Nursing: Dimensions of Praxis. (2nd ed) South Melbourne: Oxford University Press.

Evans, J., & Brown, P. (2012). Videbeck’s Mental Health Nursing. Sydney: Lippincott Williams & Wilkins.

Gilburt, H., Slade, M., Bird, V., Oduola, S., & Craig, T. K. (2013). Promoting recovery-oriented practice in mental health services: a quasi-experimental mixed-methods study. BMC psychiatry, 13(1), 167.

Happell, B., Cowin, L., Roper, C. & Lakeman, R. & Cox, L. (2013). Introducing mental health nursing: A service user-orientated approach (2nd Ed). Crow’s Nest, NSW: Allen & Unwin.

Ivey, A., Ivey, M. & Zalaquett, C. with Quirk, K., (2012) Essentials of intentional interviewing: Counselling in a multicultural world (3rd ed). Belmont, USA:Brooks/Cole Cengage Learning.

Jones, K., & Creedy, D. (2012). Health and human behaviour (3rd ed.). South Melbourne, Vic: Oxford University Press.

Leahy, R. (2012) (Ed). Treatment plans and interventions for depression and anxiety disorders (2nd ed). New York; London: Guilford Press

Le Boutillier, C., Chevalier, A., Lawrence, V., Leamy, M., Bird, V. J., Macpherson, R., … & Slade, M. (2015). Staff understanding of recovery-orientated mental health practice: a systematic review and narrative synthesis. Implementation Science, 10(1), 87.

Mental Health Commission. (2012). Blueprint II: Improving mental health and wellbeing for all New Zealanders: How things need to be. Wellington: Mental Health Commission, 52.

O’Hagan, M. (2014). Madness made me: a memoir. New Zealand: Open Box/Potton & Burton.

Slade, M., Amering, M., Farkas, M., Hamilton, B., O’Hagan, M., Panther, G., Perkins, R., Shepherd, G., Tse, S. and Whitley, R. (2014), Uses and abuses of recovery: implementing recovery-oriented practices in mental health systems. World Psychiatry, 13: 12–20. doi:10.1002/wps.20084

Williams, J., Leamy, M., Bird, V., Harding, C., Larsen, J., Le Boutillier, C., … & Slade, M. (2012). Measures of the recovery orientation of mental health services: systematic review. Social psychiatry and psychiatric epidemiology, 47(11), 1827-1835.

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MANAGED CARE ORGANISATIONS

Order Instructions:

As your third assignment toward completion of the Session Long Project you are asked to review the paper by A. Mains, A. Coustasse, K. Lykens: Physician Incentives: Managed Care and Ethics and answer the questions below.
1.Consider this idea from the paper: “Medicine is a moral enterprise. Because MCOs are involved in the delivery of medical care, they too, are moral entities. However, MCOs are also businesses.”
2.Explain the idea that the authors sought to convey.
3.Discuss the physician’s dual function under an MCO model of care.
4.What concerns do you have about the physician- patient relationship under MCOs?

Module Overview

Basically, managed care and managed care organizations (MCOs) was championed as a powerful force for containing healthcare costs. We will see that this is not necessarily the case. We will also see that managed care brings up a range of structural issues related to price fixing and market power.

In the United States after World War II, healthcare was based on an indemnity model or fee for service. In this case health insurers simply paid the bills for services ordered by physicians. These traditional plans provided few incentives for cost containment medical decisions.

Responding to the lack of cost containment measures in the indemnity model, private insurers began to “manage care” by exerting influence on the decisions made by physicians. Managed care is the process of structuring or restructuring the healthcare system in terms of financing, purchasing, delivering, measuring, and documenting a broad range of healthcare services and products.

Sometimes this process of restructuring took the form of bureaucratic rules, e.g. requiring physicians to seek administrative approval before proceeding with certain procedures. In other cases, financial incentives were used to shape physician behavior. By the mid 1990’s, “managed care” had become the dominant form of private sector health insurance.1

Today managed care organization (MCO) is a general term used to describe any number of health insurance arrangements that are intended to reduce unnecessary healthcare costs through a variety of mechanisms, including: economic incentives for physicians and patients to select less costly forms of care; programs for reviewing the medical necessity of specific services; increased beneficiary cost sharing; controls on inpatient admissions and lengths of stay; and the intensive management of high-cost healthcare cases.

Managed care organizations are structured with an imperative to consider both the impact on costs and also the impact on doctors’ decisions whether to join their networks.

These considerations by MCOs to both contain costs and attract physicians are influenced by the values and practices that physicians bring to healthcare. Physicians want to earn a living but not at the risk of endangering the lives they are meant to serve. These healthcare values held by physicians pose a strategic dilemma for managed care organizations needing to contain costs and attract physicians to assemble provider networks.

Low cost MCOs with contract restrictions on spending are seen as highly restrictive. On the other hand, MCOs with large physician networks write cost containment rules into contracts that are not overly burdensome.

It is interesting to think about how MCOs balance competing interests and ethical issues in cost containment, physician ideals, and quality of care.

There are a wide variety of managed care models that integrate financing and management with the delivery of healthcare services to an enrolled population.

Health Maintenance Organizations: HMOs are organized healthcare systems that are responsible for both the financing and the delivery of a broad range of comprehensive health services to an enrolled population. HMOs act both as insurer and provider of healthcare services. They charge employers a fixed premium for each subscriber. An independent practice association (IPA)-model HMO provides medical care to its subscribers through contracts it establishes with independent physicians. In a staff-model HMO, the physicians would normally be full-time employees of the HMO. Individuals who subscribe to an HMO are often limited to the panel of physicians who have contracted with the HMO to provide services to its subscribers.

Preferred provider organizations (PPOs) are entities through which employer health benefit plans and health insurance carriers contract to purchase healthcare services for covered beneficiaries from a selected group of participating providers. Most states have specific PPO laws that directly regulate such entities.

Exclusive provider organizations (EPOs) limit their beneficiaries to participating providers for any healthcare services. EPOs use a gatekeeper approach to authorize non–primary care services. The primary difference between an HMO and an EPO is that the former is regulated under HMO laws and regulations, whereas the latter is regulated under insurance laws and regulations.

These integrated health delivery organizations raise a variety of issues with the Department of Justice and the Federal Trade Commission. The issues include price fixing and antitrust problems based on market power.

Depending on how the groups are organized- horizontal versus vertical- and who is integrated- competing physician groups or a multi provider network a MCO may violate several antitrust laws.

Whenever an MCO possesses significant market power or deals with a group that has significant market power, antitrust implications should be considered. To determine market power, it is necessary first to identify the market in which the entity exercises power. For antitrust purposes, the relevant market has two components: (1) a product component and (2) a geographic component.

Price fixing is considered a per se violation of the antitrust laws. Per Se Violations conclusively violate antitrust laws and means there is no further investigation of its effects on the competitiveness of the market because its intentions are so obvious. A Per Se Violation would almost always limit competition and decrease productivity. Activities that fall under per se violations are acts such as horizontal price fixing and horizontal market division.

Price fixing occurs when two or more competitors come together to decide on a price that will be charged for services or goods. The per se rule applies to restraints in trade that are so inimical to competition and so unjustified that they are presumed to be unreasonable and, therefore, are illegal.

Aaron, Henry J. and Reischauer, Robert D., (1995) “The Medicare Reform Debate: What is the Next Step?” Health Affiars. 14:4. p.8-30

Required Reading

D.A. Mains, A. Coustasse, K. Lykens: Physician Incentives: Managed Care and Ethics. The Internet Journal of Law, Healthcare and Ethics. 2004 Volume 2 Number 1. DOI: 10.5580/24ae – See more at: http://ispub.com/IJLHE/2/1/12416

Managed Care and Physician Incentives: The Effects of Competition on the Cost and Quality of Care. David J. Cooper and James B. Rebitzer. March 2004. http://myweb.fsu.edu/djcooper/research/managedcare.pdf

Government Agencies Soften Stance on What Constitutes Price Fixing. David A. Ettinger and Mark L. Lasser (March, 2008) http://corporate.findlaw.com/litigation-disputes/government-agencies-soften-stance-on-what-constitutes-price.html

Diagnosing Physician-Hospital Organizations. Susan A. Creighton. Federal Trade Commission Remarks Before American Health Lawyers Association, Program on Legal Issues Affecting Academic Medical Centers and Other Teaching Institutions. January 22, 2004. Washington, DC. Retrieved from: http://www.ftc.gov/public-statements/2004/01/diagnosing-physician-hospital-organizations

Statement of department of justice and federal trade commission enforcement policy on multiprovider networks; Federal Trade Commission; Competition in The Healthcare Market place; Statements of Health Care Antitrust Enforcement Policy; Statement 9. (July 8, 2009). Retrieved from: http://www.law.uh.edu/faculty/jmantel/health-law/Statement9AntitrustEnforcementPolicy.pdf

The above policy has been updated (Statement 9 on Multi-provider Network), Read the updates below:

Revised Statements on Multi-provider networks: http://corporate.findlaw.com/law-library/revised-policy-statements-on-health-care-antitrust-enforcement.html

Optional Reading

Competition in the healthcare marketplace. http://www.ftc.gov/bc/healthcare/antitrust/index.htm

Improving Health Care: A Dose of Competition: A Report by the Federal Trade Commission and the Department of Justice (July 2004). http://www.ftc.gov/reports/healthcare/healthcarerptexecsum.pdf

QuickCounsel Antitrust: U.S. Laws and Regulations. Elizabeth Killingsworth, Esq. http://www.acc.com/legalresources/quickcounsel/auslar.cfm

SAMPLE ANSWER

MANAGED CARE ORGANISATIONS

“Medicine is a moral enterprise. Because MCOs are involved in the delivery of medical care, they too are moral entities. However, MCOs are also businesses.”

MCOs are moral entities because they aim at deliver quality, safe and effective medical care. They are responsible of doing what is right and best for the service users while ensuring equitable distribution of the scarce health resources. However, the managed care control changes the patient physician relationship to a business-consumer relationship. This implies that the main goal of MCOs is to ensure that physicians adopts the principle of distributive ethic; which is basically providing the most safe and best quality of care to the greatest number of patients as possible using the allotted budget or incurring losses (Mains, Coustasse, & Lykens, 2004).

Under this moral obligation, the MCOs are guided by the utilitarianism- which basically entails performing the best action that maximizes utility. However, the MCOs are economic tenets that aim at reducing costs for service users and aims at generating profit simultaneously. Therefore, when making decisions regarding MCOs, providers should consider the economic effects when maintaining aggregating costs of care so as to avoid loses in either the MCOs or the physicians. This involves establishing control, incentives, bonuses, and withholds as well as other quality assurance initiatives that will ensure that physician practices are safe, quality and profit generating (Cooper and Rebitzer, 2004).

Physician dual function

In managed care, the physicians have dual functions namely a) patient fiduciary and b) Financial advocates. The physician play the unrestricted role of patient advocates by ensuring that the managed care model puts into consideration to patient’s autonomy, respects it, and exercise the ethical principle of beneficence. This implies that the physicians are patient’s advocates in voicing their concerns whenever the managed care model prioritizes its benefits over the patient’s interests, or any other good that is beyond establishing effective physician-patient relationship. This is an important role because the MCOs require expects the physicians to choose the society wellbeing over individual patient’s interest (Mains, Coustasse, & Lykens, 2004).

Therefore, when enrolling in these organizations, it is important for the physicians to understand that their first role is to be patient advocates. Under patient fiduciary role, the physicians are legally responsible for advising patients about all possible alternative care or technological advancement that can be used to manage their illness. The physicians are expected to remain prudent steward when advising and deciding the limits of patient care. This entails balancing between medical merits and financial risks. Trust, honesty and caring are foundation of establishing effective physician-patient fiduciary relationship (Cooper and Rebitzer, 2004).

Concerns about physician-patient relationship

Managed care is associated with moral and professional ethical dilemmas. For instance, MCOs focus on financial incentives and social optimal outcomes instead of single patient well-being. This brings forth the concept of “countervailing agency” which is basically the physician’s role to choose between individual patient’s interests and the society wellbeing. If a patient does not receive care as by MCOs, the physicians can be sued for malpractice. This puts the physicians at dilemma of delivering care based on MCOs expectations and risk for liability (Mains, Coustasse, & Lykens, 2004).

In addition, the MCOs emphasize on utilitarianism approach when solving the healthcare expenditure. Despite its advantages, this approach raises concerns of its validity and morality in physician- patient relationship. The professional sovereignty vs. physician financial incentives complex interaction results into a conflict of interest. It is important for the managers in healthcare system to choose a strategy that helps them identify how to favor the interests of the patients and the society. This calls for reforms to re-define the moral mission for MCOs to fulfill their goals and to preserve efficient physician-patient relationship ( Improving Health Care, 2004).

References

Cooper, D.J., and Rebitzer, J.B. (2004). Managed Care and Physician Incentives The Effects of Competition on the Cost and Quality of Care. Retrieved from http://myweb.fsu.edu/djcooper/research/managedcare.pdf

Mains, D.A., Coustasse, A., & Lykens, C.K. (2004). Physician Incentives: Managed Care and Ethics. The Internet Journal of Law, Healthcare and Ethics. Volume 2 Number 1. DOI: 10.5580/24ae – Retrieved from http://ispub.com/IJLHE/2/1/12416

Improving Health Care (2004). A Dose of Competition: A Report by the Federal Trade Commission and the Department of Justice. Retrieved from http://www.ftc.gov/reports/healthcare/healthcarerptexecsum.pdf

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Peritonitis Essay Paper Assignment Available

Peritonitis

Order Instructions:

Assignment Instructions
• You will each choose 3 different journal published research study articles that explain the patient’s behavioral and/or psychological responses to having the illness. Do not include articles discussing the physiology or pharmacology of the illness, treatment of the illness or behavioral/psychological responses, or the risk factors for first developing the illness.
• Locate relevant journal published research study articles (these articles need to have been written after 1997 and you must NOT use general literature review articles.
• Choose the 3 articles that best relate to your case study patient.
• Briefly summaries the main topic and focus of each study and include a very summary of the study’s methodology, results, and discussion (i.e. where the authors explain the reasons for their findings and research conclusions) for the articles;
• discuss how each article explicitly and specifically explains the behavioral and psychological responses that the patient in your case study is experiencing in response to their illness.
• Make sure you are using article databases such as PsycINFO, MEDLINE, and CINAHL to run your searches. PsycINFO is likely to find you the most relevant articles for this assignment and all assignments within the behavioral stream. Just using Google or Google Scholar will NOT find you the articles you need. Also, make sure that the search terms you are using will give the databases the best chance of returning the articles you want. If you get no results with one search term, then try another or try and think laterally (e.g. what might be another word for “aggression” that you might find in the literature… hint: what about “irritability”? Or another word for “anxiety” might be “fear” etc.).
• The articles you include must have been published in a journal. Do not include theses, magazines, books or book chapters, letter to the editor or news articles. Academic journals publish all sorts of articles including research studies, book reviews, general literature reviews, editorials/commentaries, letters) but for the articles you include in your Annotated Bibliography you need to use only research study articles. A research study article will describe in detail a qualitative or quantitative research study (e.g., an experiment) including information about the study’s methodology, results, discussion and conclusions. For example, the Module 1 reading Zeilani and Seymour (2012) qualifies as a research study article because the authors describe how they collected and analyzed their data. A Module 3 reading, Lusk and Lash (2005) is a general literature review and does not qualify as a research study as the author does not specify how they went about sourcing information for their article. Lusk and Lash’s article is still a credible and valid source of reference information but it is not a research study and so cannot be used in the Annotated Bibliography assignment.

SAMPLE ANSWER

Peritonitis is a health condition that involves the inflammation of peritoneum (thin protective tissue layer that underlie the abdomen). This health condition is caused by infection which spreads around the body. It requires immediate treatment to prevent fatal complications from arising. In patients who have undergone surgical treatment, autonomic responses, mood swings and psychological coping responses are common. This paper explores 3 different journal study articles that explain patient’s behavioral and psychological responses to this illness. This study focuses on behavioral and psychosocial responses following surgical responses.

Boer, K. R., Mahler, C. W., Unlu, C., Lamme, B., Vroom, M. B., Sprangers, M. A., … Boermeester, M. A. (2007). Long-term prevalence of post-traumatic stress disorder symptoms in patients after secondary peritonitis. Critical Care, 11(1), R30.

Introduction/Literature review: This study investigates the behavioral response following secondary peritonitis. This is because numerous hospital admissions and intensive care unit (ICU) can be physically, emotionally and financially exhaustive. Patients who survive critical illness report critical poor quality of live and symptomology (PTSD) such as numbing, anxiety, loss of avoidant and intrusive recollections. The study suggests that the behavioral interventions are vital in patients with secondary peritonitis.

Methodology: This is a retrospective cohort in patients diagnosed with secondary peritonitis. The study comprises of 278 patients who had undergone surgery for secondary peritonitis, where 131 of them were long term survivors. The patients were interviewed Post-traumatic Stress Syndrome 10-question inventory (PTSS-10).

Study/ Results: The study indicates that in a cohort of 100 patients diagnosed with secondary peritonitis, 86% of them presented with post traumatic stress disorder. PTSD related symptoms were also present in 4.3 times higher in older male patients.

Discussion/explanation: The study indicates that 25% patients who have received surgical treatment for peritonitis are likely to be emotionally and physically upset due to surgical-related trauma, which could exacerbate illness behavior. The study suggests that patterns of behavior are seen as a product of socio-cultural conditioning and coping strategies. The study suggests that healthcare providers should recognize patient’s responses to various health procedures associated with pain and anxiety. Other symptoms such as impaired appetite, lack of energy and disturbed sleep can occur due to illness. In addition, some treatments can affect patient’s mood. These conditions can also be aggravated by other environmental factors such as financial strain of lack of physical and emotional support.

Application to the case study: The study findings contribute to the body of research that demonstrates that psychosocial responses in patients are associated with the socio-cultural factors. The suggests that the healthcare providers should incorporate psychosocial interventions in routine care so as to help patients such as Mr. Jacobs to manage stress associated with their new lifestyles of dependency, helplessness and pain. It is important for the healthcare providers to identify and be aware of this hidden morbidity among the patients diagnosed with secondary peritonitis.

Jennifer Finnegan-John and Veronica J. Thomas, “The Psychosocial Experience of Patients with End-Stage Renal Disease and Its Impact on Quality of Life: Findings from a Needs Assessment to Shape a Service,” ISRN Nephrology, vol. 2013, Article ID 308986, 8 pages, 2013. doi:10.5402/2013/308986

Introduction/Literature review: This study investigates the psychosocial experiences in patients with end stage renal disease. The study conducts needs assessment on renal patients to explore their psychological, spiritual and social needs. The study objective was to investigate behavioral responses and to conduct needs assessment so as to develop a comprehensive health psychology that can run concurrently with renal counseling.

Methodology: The study design is prospective qualitative. The study population consisted of 50 patients with end stage renal disease. The mean age of the participants was 55 years and 40% of them were from black and minority ethnic group. The study utilized series of semi- structured face to face interviews in renal patients and their carers in order to explore their behavioral and psychological responses and how the disease impacted their quality of life.

Study/ Results: The study findings indicated that depressive symptoms and disruptive behaviors are common in renal patients. This is associated with the psychological burden associated with the disease. Most of the patients in the study had feelings associated with depression and anxiety.

Discussion/explanation: This retrospective study indicates that depression and anxiety is a common behavioral response in patient diagnosed with renal disease. The study suggests that about 25% of patients who are diagnosed with the disease suffer from psychological burden. This behavioral response is associated with emotional numbness, avoidance of social activities and events. It is also associated difficulty in sleeping, disruptive and reckless behavior and is easily irritated. The study states that these are body responses to stress or perceived threat.

Application to the case study: The study indicates that depression and anxiety is a behavioral response that goes beyond the mental health. Based on this study, Mr. Jacob’s behavioral responses (irritability, social isolation and binge drinking) could be associated with the emotional burden of the disease. This research is interesting because it suggests that healthcare providers should engage with psychiatrists to help them better manage their improved outcome health.

Mckercher, C.M., Venn, A.J., Blizzard, L., Nelson, M., Palmer, A., Sshby, M., Scott, J., and Jose. M.D. (2012). Psychosocial factors in adults with chronic kidney disease: characteristics of pilot participants in the Tasmanian Chronic Kidney Disease study. BMC Nephrology, 14:83DOI: 10.1186/1471-2369-14-83

Introduction/Literature review: This study investigates behavioral and psychosocial responses in patient diagnosed with chronic illness. The literature links health outcomes with depression, anxiety and dispositional tendency described by aggression, cynicism attitudes and anger/irritability. The study also indicates that hostility, anger and depression are related with renal failure experiences. According to this study, these psychosocial responses are controlled by biomedical risk factors, and are associated with most aspects of immune function.

Methodology: This study design is quantitative. The study consisted of 105 patients above 18 years diagnosed with stage 4 CKD and was not under dialysis. The measures used in this study include depression (9- item patient Health questionnaire) and Beck Anxiety Inventory to investigate behavioral responses with disease progression and patient’s quality of life.

Study/ Results: The study findings indicated that hostility and patient’s behavioral responses to chronic disease are correlated with their plasma levels of CRP. The study findings indicated that the cycle of inflammation levels influence depressive behavior, indicating that depression is problematic indicator of patients under chronic pain.

Discussion/explanation: The longitudinal study findings indicated that there is a relationship between the CRP levels and psychosocial factors. The study also states that hormonal changes also induce inflammatory processes which in turn influence psychosocial responses. For instance, pain initiates systemic stress which activates neuro-endocrinological pathways (hypothalamic-pituitary-adrenal axis) leading to the secretion of stress hormone. Accumulation of stress hormone is associated with hostility and depressive symptoms. The study also suggests that genetic predispositions play a major role in both inflammation and hostility.

Application to the case study: The study findings contribute to the body of research that demonstrates that psychosocial responses in patients are associated with systemic inflammation. This indicates that the Mr. Jacob’s depressive behavior (irritability, social isolation and binge drinking) is associated with elevated levels of the systemic inflammation. This research is interesting because it suggests that healthcare providers should reduce systemic inflammation so as to improve patient’s ability to improve pain, and to help them cope with the illness-induced stress in their lives.

References

Jennifer Finnegan-John and Veronica J. Thomas, “The Psychosocial Experience of Patients with End-Stage Renal Disease and Its Impact on Quality of Life: Findings from a Needs Assessment to Shape a Service,” ISRN Nephrology, vol. 2013, Article ID 308986, 8 pages, 2013. doi:10.5402/2013/308986

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Healthcare Provider and Faith Diversity

Healthcare Provider and Faith Diversity Order Instructions: The practice of health care providers at all levels brings you into contact with people from a variety of faiths.

This calls for knowledge and acceptance of a diversity of faith expressions.

The purpose of this paper is to complete a comparative analysis of two faith philosophies towards providing health care, one being the Christian perspective. For the second faith, choose a faith that is unfamiliar to you. Examples of faiths to choose from Sikh, Baha’i, Buddhism, Shintoism, etc.

In a minimum of 1,100-2,000 words, provide a comparative analysis of the different belief systems, reinforcing major themes with insights gained from your research.

In your comparative analysis, address all of the worldview questions in detail for Christianity and your selected faith. Refer to chapter 2 of the Called to Care: A Christian Worldview for Nursing for the list of questions. Be sure to address the implications of these beliefs for health care.
•What is prime reality?
•What is the nature of the world around us?
•What is a human being?
•What happens to a person at death?
•Why is it possible to know anything at all?
•How do we know what is right and wrong?
•What is the meaning of human history?

In addition, answer the following questions that address the practical and healthcare implications based on the research:
1. What are critical common components to all religions/beliefs in regards to healing, such as prayer, meditation, belief, etc.? Explain.
2. What is important to patients of the faiths when cared for by health care providers whose spiritual beliefs differ from their own.
In your conclusion, describe your own spiritual perspective on healing, what you have learned from the research and how this learning can be applied to a health care provider.

Support your position by referencing at least three academic resources (preferably from the GCU Library) in addition to the course readings, the Bible, and the textbooks for each religion. Each religion must have a primary source included. A total of six references are required according to the specifications listed above. Incorporate the research into your writing in an appropriate, scholarly manner

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center.

Healthcare Provider and Faith Diversity Sample Answer

HEALTHCARE PROVIDER AND FAITH DIVERSITY

Abstract

The different belief systems result to the varying perspectives by the faith philosophies in regards to how healthcare should be provided. Adequate knowledge and diversity are among the crucial elements that should be possessed by the healthcare providers since the patients they serve are from diverse faith domination. In this case, spirituality is considered when providing healthcare with the aim of ensuring the people from a variety of faiths get the satisfaction of the services. In this paper, the focus would be on the two faith philosophies namely Buddhism and Christianity.

Healthcare Provider and Faith Diversity and Healthcare Care Provider and Faith Diversity

The Christianity and Buddhist faiths represent the spiritual diversity of the patients served in the healthcare systems. The Buddhist have put their belief on meditation which is considered essential for their followers on healing. The provision of healthcare and healing for Christianity is that God heals people through the prayers they dedicate to him. The administration of Medicare among the two faith philosophies is said to contribute to the differing perspectives (Sullivan et al., 2014). An example is the yoga practices and meditation among the Buddhist which is believed to enhance better health status and quick recovery as per Buddha their founder. Such practices are also believed to help in achieving self-confidence optimism resulting in reduced suffering. On the other hand, yoga is not practiced among the Christians which is in contrast to the Buddhist.

Healthcare Provider and Faith Diversity and Worldview Question Responses

The Christians consider the prime reality to be the infinite and personal God only revealed through the Holy Scripture. In this case, he is triune, transcendent, omniscient and sovereign. The Christians are of the belief that the reality of God comes up through the powerful ways he reveals himself to human beings. On the other hand, the Buddhist does not believe in the existence of the prime reality in either the spiritual substance or material substance form. The transcendent truth governing the universe and people is considered by the Buddhist to be the prime reality. The Christians believe that the world is imperfect and disorderly in nature where all human beings are exposed to cause sin. They also view the world as a human-made machine that is created by the superior being with a reason. The Buddhist consider the world as an impersonal existence ground that is neither favorable nor evil for human beings (Lopez, 2015). The Christians consider a human being as a creature that cannot be degraded since it is created in the image and likeness of God thus making humanity valuable. A special status is also accorded to the human beings among the Buddhist who consider them as of great value similar to the Christians.

The Christians are of the belief that the souls go to heaven after death and would be later joined by the physical body upon resurrection. Rebirth and reincarnation are believed to take place after the occurrence of death as for the Buddhist. Communicating with human beings is an active role played by God thus making it possible to know anything since God has created people with the ability and the right capacity as for the Christians. Based on the revelations, the Buddhist hold that it is possible to know everything. The belief system where people operate in reference to morality is used in discerning what right and wrong among the Christians. The code of morality developed among the Buddhist faith is also considered useful in discerning right or wrong. The precepts include avoiding sexual misconduct, stealing, killing, and other evil deeds. The Buddhist believe that human beings have no beginning or end thus inconceivable (Lopez, 2015). Redemption and creation are where humanity lies as for the Christians while the rest is on the history provided by the Bible.

Healthcare Provider and Faith Diversity and the Critical Components to the Buddhism Religion

Seeking divine intervention is considered to be a critical component in the Buddhism religion. They also believe in the physical and spiritual healing. The Christians share the same beliefs with the Buddhists when it comes to spiritual and physical healing. The Christians hold that displaying the cross and making prayers to the Almighty God as their crucial components which differ from Buddhism. The Buddhist does not consider prayers as part of the spiritual support accorded to them by the clergy as for the Christian religion. The precept and meditation are both included as practices among the Buddhist. The tranquility and insight types of meditation make up the meditation practices in Buddhism religion. The spiritual practices are given emphasis in the healing and health approach adopted by the Buddhist. The Buddhist is focused on mental development through the involvement and perfection of compassion and wisdom (Tomkins et al., 2015). The healthcare providers offer assistance to the patients that are interested in the practices adopted in the Buddhism religion. Adherence to the practices and beliefs of Buddhism is envisioned as the holistic type of health in the religion. The Buddhist have no problem with the healthcare providers as long as the patients are allowed to practices the critical components in their religion (Tomkins et al., 2015). In this case, meditation and prayers are vital when it comes to mental and spiritual health. They believe that health practices are complemented by the practices adopted in their religion. The deeper insight of the health conditions is made possible through Buddhist practices. In this case, prayer and meditation are critical components that enhance reduced suffering and quick healing.

Healthcare Provider and Faith Diversity and Critical Components to the Christianity Faith

Displaying the cross and praying are considered to be the main components of the Christian faith. Similar beliefs are also identified among most of the healthcare providers caring for Christian patients. Prayer can be used as an alternative therapy during healing thus complementing the services offered by the practitioners (McGrath, 2016). Good health and healing are believed to be acquired through prayers made to the Supreme Being God. There are cases where the prayers are administered to accelerate healing before the performance of the medical practices such as surgery. The Christians expect that health care providers respect their beliefs in regards to healing. The better healing process is achieved when the Christians pray for generosity, protection, and love which are essential components in the religion. Engaging with the spiritual dimensions is believed to be an important component in enhancing the wellbeing of the Christians. In this case, the Christian faith emphasizes on prayer as the critical component while in the Buddhism religion meditation is considered more important than prayers when it comes to healing and health care matters (McGrath, 2016).

Healthcare Provider and Faith Diversity and Important Factors to Christians and Buddhism Religions during Healthcare Provision

The patients believe in some important factors to be considered especially while receiving care from healthcare providers from other religions. The Christian faith holds that care providers should practice patient-centered care while also considering their practices during the treatment process (Hossler, 2012). It is paramount to show unconditional love to the patients during provision of care to them. Adherence to these principles enhances better healing and good health. In Buddhism religion, the care providers are supposed to be mindful and exhibit love to the patients. The Buddhists believe that it is good for the care providers to work in conjunction with the clergy thus enhancing the sense of greater acceptance among the patients. The Buddhist also require healthcare providers from other religions to practice patient-centered care. Getting inspirations from the healthcare providers are also considered significant in the Buddhism religion. Both the Christians and Buddhist are of the belief that the practitioners should work towards addressing the spiritual, physical and emotional needs of the patients irrespective of their faith (Pesut, 2012). The healthcare providers are also expected not to force their beliefs to the patients under their care. Adhering to the human morals and maintenance of love are considered essential in both Christians and Buddhists.

Healthcare Provider and Faith Diversity Conclusion

The spiritual perspective I hold onto is that prayers are essential during the process of healing. However, other practices such as meditation which are major components in other beliefs such as the Buddhist should not be despised but respected. The most important thing learned is that the patients ought to be respected while the services provided should be suited to their belief since it contributes positively to better health and quick healing. The learnings should be applied to healthcare providers through the training curriculum. Such initiatives would help healthcare providers to better comprehend the differing perspectives of the patients in regards to healing thus enabling them to adopt the best measures to suit their beliefs (Pesut, 2012). In this case, everyone’s interests would be safeguarded by the efficient healthcare services they receive.

Healthcare Provider and Faith Diversity References

Hossler, P. (2012). Free health clinics, resistance and the entanglement of Christianity and commodified health care delivery. Antipode, 44(1), 98-121.

Lopez Jr, D. S. (2015). Buddhism in Practice 🙁 Abridged Edition). Princeton University Press.40 (1), 30-76.

McGrath, A. E. (2016). Christian theology: An introduction. John Wiley & Sons.5 (2), 34-45.

Pesut, B., Reimer-Kirkham, S., Sawatzky, R., Woodland, G., & Peverall, P. (2012). Hospitable hospitals in a diverse society: From chaplains to spiritual care providers. Journal of religion and health, 51(3), 825-836.

Sullivan, S., Pyne, J. M., Cheney, A. M., Hunt, J., Haynes, T. F., & Sullivan, G. (2014). The pew versus the couch: Relationship between mental health and faith communities and lessons learned from a VA/Clergy partnership project. Journal of religion and health, 53(4), 1267-1282.

Tomkins, A., Duff, J., Fitzgibbon, A., Karam, A., Mills, E. J., Munnings, K., … & Yugi, P. (2015). Faith-based health care 2 Controversies in faith and health care.

Medical Healthcare Records Data Quality

Medical Healthcare Records Data Quality Order Instructions: Data Quality For your selected organization, create three sample Medical Records with the mandatory fields (1 per page. Use these fields to capture pertinent data as if you were an actual patient. Using the guidelines from MRI and AHIMA indicate how the information would be captured (paper or electronically).

How would the quality of data you evaluate compare with your expectations?

Medical Healthcare Records Data Quality Module Overview

Healthcare systems are driven by data, which is translated into useful information that can be used by organizations, providers, researchers, and consumers. The information used must be reliable so decisions that are made are appropriate, using the data and information available. When there are errors in the data, patient care, research, and courses of action suffer. This module examines the impact of poor data quality and how to prevent it.

Data Quality

The management of health information is a major concern from both a quality of care as well as a medicolegal perspective. There is a need for quality of data to ensure safe and appropriate patient care. One of the biggest challenges in capturing reliable and valid data is the understanding of the importance of data and protecting it from all levels of the organization, which include support staff, providers, administrators, and executives.

The problem with poor data quality is that data is gathered at the user level. Clinical providers and support staff typically enter data. When there are mistakes in data entering, it translates into problems in patient care, reimbursement, and research. The problem of poor data crosses departments and organizations, filtering into decisions that are made based on the data.

As a result of the importance of data quality, two organizations were developed: American Health Information Management Association (AHIMA) and Medical Records Institute (MRI). Both organizations developed standards to facilitate the move from paper to an electronic health information system. AHIMA developed a data quality model and MRI used a consensus group to present some of the challenges of capturing data electronically, including recommendations.

Medical Healthcare Records Data Quality Required Reading

Lorence, D., & Chen, L. (2008). Disparities in Health Information Quality Across the Rural-Urban Continuum: Where is Coded Data More Reliable? Journal of Medical Systems, 32(1), 1-8. Retrieved from ProQuest Computing. (Document ID: 1897506551).

Mooney, S. E. (1998, October). Health information management experts outline steps to data quality. Clinical Data Management, 5(7), 10. Retrieved from ProQuest Nursing & Allied Health Source. (Document ID: 35023770).

American Health Information Management Association (1998). Practice Brief: Data Quality Management Model.

Waegemann, C. P., Tessier, C., Barbash, A., Blumenfeld, B. H., Borden, J., Brinson, R. M., Jr., Cooper, T. … Weber, J. (2002). Healthcare documentation: A report on information capture and report generation. Medical Records Institute.

Medical Healthcare Records Data Quality Sample Answer

How the mandatory fields would compare with my expectations.

In all the three samples, the mandatory fields include patient’s identifiers, the reason for a hospital visit, review of the systems, allergies, diagnosis and care plan. The last sample only captures on patient’s physical examinations, and therefore leaves out on diagnosis and treatment. The benefit of mandatory fields in the Electronic Medical record is that they act as reminders and enhances patient’s safety. This implies that the healthcare providers must be extra careful when filling the field in order to store capture vital information. The mandatory field must be updated regularly in order to prevent medical errors (Bowman, 2013).

Therefore, it is important for a healthcare provider to take time and decide the mandatory fields important in their practice, and ensure that the Electronic medical record is configured in a way that one cannot bypass or disable the fields. My expectation of these mandatory fields is that they will help improve patient safety, efficiency and quality, as well as help, assess potential health disparities. This information will also help maintain patient information private and enhance coordinated care (Linder, Schnipper, & Middleton, 2012).

Medical Healthcare Records Data Quality References

Linder, J. A., Schnipper, J. L., & Middleton, B. (2012). Method of electronic health record documentation and quality of primary care. Journal of the American Medical Informatics Association : JAMIA, 19(6), 1019–1024. http://doi.org/10.1136/amiajnl-2011-000788

Bowman, S. (2013). Impact of Electronic Health Record Systems on Information Integrity: Quality and Safety Implications. Perspectives in Health Information Management, 10(Fall), 1c.
Systematic data collection form

Name: Myres Jacob Gender: Female Age : 31y/o	Height: 6’0” Weight: 188lbs		Allergies: cold/dust
CC : c/o of nasal congestion and dry cough that started seven days ago
HPI: The patient is 31 y/o Hispanic female reported to the clinic with c/o of nasal congestion and a dry cough that started seven days ago. She reported that she has seasonal allergies and was under Metformin 500mg medicine. The review of the system was remarkable except for that she had regular but labored respirations, wheezing sound, productive cough with tan sputum.
Medical history: NONE
Family/social history Father is 79 y/o alive and suffering from prostate cancer. Mother is 76 years old, alive and asthmatic. Brother is 45 years old, alive and healthy. She is a nursing student schooling at a local community college. She lives alone and is not dating
Medication Metformin Route oral frequency twice Dosage 500mg
Physical exam: Remarkable
ROS The review of the system was remarkable except for that she has regular but labored respirations, wheezing sound, productive cough with tan sputum
Diagnostic tests v CBC- pending v Peak flow v Allergy test v Spirometry
Clinical notes v Asthma: suspected because the patient has had the history of an asthma attack, fatigue, SOB and cough		Care plan: – Prednisone 40mg PO BID for 3 days, Refill ProAirHFA (albuterol sulfate) inhaler – Promethazine DM syrup Q4-6hr

On-call physician medical record

Date: 03/23/17

To: Mr. Raghav, M .

Re: Patient Myre Jacobs Age: 31 years Gender: Female

This patient phoned on 23rd March, 2017 at 10.30 o’clock.

I saw this patient in office Emergency department 23rd March, 2017 at 10.30 o’clock.

Complaint/History/Allergies/Medication

The patient is 31 y/o Hispanic female reported to the clinic with c/o of nasal congestion and a dry cough that started seven days ago. She reported that she has seasonal allergies and was under Metformin 500mg medicine. The review of the system was remarkable except for that she had regular but labored respirations, wheezing sound, productive cough with tan sputum

Examination:

v CBC- pending

v Peak flow

v Allergy test

v Spirometry

Impression:

v Asthma: suspected because the patient has had the history of an asthma attack, fatigue, SOB and cough

Action/Advice: Admitted to keep warm and avoid allergens. Patient advised to call in 14 days or if symptoms persist after 24 hrs.

Medication prescribed

– Prednisone 40mg PO BID for 3 days, Refill ProAirHFA (albuterol sulfate) inhaler

– Promethazine DM syrup Q4-6hr

Physician initials R. M. . Date 23^rd March, 2017 Pharmacy J.K. L Date 23rd March, 2017

Attachment

IME#

Family Name: Jacob’s

Given name (s): Myre

Date of birth (YYYY-MM-DD): 1986-05-29

For abnormal findings, please give History, diagnosis, treatment plan (include date &medications), lab results, specialist reports, current status/prognosis

Physical examination

Response/Normal

Remarks

Height 6’ 0”

Normal range

Weight 188lbs

Normal range

BMI 25.54

Normal range

Bp 120/75

Normal range

RR 15 laboured

Abnormal

Ear/Nose/Throat/Mouth

No hearing difficulties, no nose bleeds, denies dental problems, nasal congestion associated with yellowish-mucous discharge

Eyes (include fundoscopy)

No eyesight changes, denies itchy eyes

Breast examination

Deferred

Cardiovascular system

Denies palpitation or angina, no murmurs, gallops or rubs

Respiratory system

Regular respirations (labored) wheezing sound, productive cough with tan sputum

Nervous system (sequeale of cerebral palsy, stroke or other neurological disabilities

Denies neurological disorders

Cognitive state

No cognitive impairements

Gastrointestinal system

Normal bowel movements, no changes in appetite

muscoskeletal

No injuries or backache issues, ROM in all quadrants

Endocrine system

Denies any health complication

Other physical or mental health condition

None

NKDA

Medical record: Physical Examination

Federal Healthcare and Veterans Affairs Hospitals

Federal Healthcare and Veterans Affairs Hospitals Order Instructions: You volunteer with a nonprofit organization that works to connect low income populations with health care resources.

The volunteer coordinator expressed an interest in determining how quality improvement was incorporated at each site.

Research five regional Veterans Affairs (VA) hospitals and federally qualified health centers. In an essay of 850-1,000 words, summarize your findings for each hospital or health center in regards to current quality improvement measures. Focus on continuous quality improvement and the benefits these have for the populations receiving care.

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center.

1
Unsatisfactory
0.00%

2
Less than Satisfactory
65.00%

3
Satisfactory
75.00%

4
Good
85.00%

5
Excellent
100.00%

80.0 %Content

80.0 % Paper on Veteran Affairs Hospitals and Federally Qualified Health Centers

Paper does not demonstrate an understanding of the assignment. Paper does not include number of references as specified in the assignment. Paper does not demonstrate critical thinking and analysis of the references listed.

Paper demonstrates minimal understanding of the assignment. Paper does not include the number of references as specified in the assignment. Paper demonstrates minimal abilities for critical thinking and analysis of the references listed.

Paper demonstrates knowledge of concept of the assignment, but has some slight misunderstanding of what to include. Paper includes the number of references as specified in the assignment. Paper provides a basic idea of critical thinking and analysis of the references listed.

Paper demonstrates acceptable knowledge of the concept of the assignment. Paper includes the number of references as specified in the assignment. Paper develops an acceptable response and rationale for the references listed.

Paper demonstrates thorough knowledge of the assignment. Paper thoroughly develops an understanding of the references as specified in the assignment. Paper clearly develops a very strong rationale for the references listed.

10.0 %Organization and Effectiveness

5.0 % Paragraph Development and Transitions

Paragraphs and transitions consistently lack unity and coherence. No apparent connections between paragraphs are established. Transitions are inappropriate to purpose and scope. Organization is disjointed.

Some paragraphs and transitions may lack logical progression of ideas, unity, coherence, and/or cohesiveness. Some degree of organization is evident.

Paragraphs are generally competent, but ideas may show some inconsistency in organization and/or in their relationships to each other.

A logical progression of ideas between paragraphs is apparent. Paragraphs exhibit a unity, coherence, and cohesiveness. Topic sentences and concluding remarks are appropriate to purpose.

There is a sophisticated construction of paragraphs and transitions. Ideas progress and relate to each other. Paragraph and transition construction guide the reader. Paragraph structure is seamless.

5.0 % Mechanics of Writing (includes spelling, punctuation, grammar, language use)

Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice and/or sentence construction are used.

Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register), sentence structure, and/or word choice are present.

Some mechanical errors or typos are present, but are not overly distracting to the reader. Correct sentence structure and audience-appropriate language are used.

Prose is largely free of mechanical errors, although a few may be present. A variety of sentence structures and effective figures of speech are used.

Writer is clearly in command of standard, written, academic English.

10.0 %Format

5.0 % Paper Format (use of appropriate style for the major and assignment)

Template is not used appropriately, or documentation format is rarely followed correctly.

Appropriate template is used, but some elements are missing or mistaken. A lack of control with formatting is apparent.

Appropriate template is used. Formatting is correct, although some minor errors may be present.

Appropriate template is fully used. There are virtually no errors in formatting style.

All format elements are correct.

5.0 % Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style)

Sources are not documented.

Documentation of sources is inconsistent and/or incorrect, as appropriate to assignment and style, with numerous formatting errors.

Sources are documented, as appropriate to assignment and style, although some formatting errors may be present.

Sources are documented, as appropriate to assignment and style, and format is mostly correct.

Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.

100 % Total Weightage

Federal Healthcare and Veterans Affairs Hospitals Sample Answer

FEDERAL HEALTHCARE

Introduction

In the past one decade there has been rapid expansion of medical knowledge and technology. However, some of healthcare facilities continue to perform poorly in areas that address patient needs and patient safety. The Institute of Medicine publication To Err is Human highlights the increasing public demand for quality improvement in healthcare facilities. For instance, it has been estimated that medical errors in the USA caused approximately 44,000 to 98,000 deaths annually. This indicates the importance to create reliable as well as sustainable healthcare improvements (Pittsburg VA, 2013) . This paper explores 5 regional Veterans Affair (VA) hospitals and federal healthcare centers Pennsylvania in regards to continuous quality measures being integrated in these healthcare facilities and the benefits of these improvements to the populations receiving these care.

VA Pittsburg Healthcare system, Highland Drive Division and Federal Healthcare and Veterans Affairs Hospitals

This VA healthcare facility has implemented several measures to improve quality of care. For instance, the new staffing model and its total adherence for call center has enabled reduced waiting times from 50% to 5%. These efforts have also improved the appropriateness and efficiency and improved quality of care. The patients have praised the fewer busy schedules and shorter waiting time which have been improved by the new customer care service model. New primary clinics have also been opened at Heinz and University Drive campuses which have expanded delivery of cases including behavioral health and mental health emergencies (Pittsburg VA, 2013).

The primary care at VAPHS utilize Patient Aligned Care Teams (PACT) model with the aim of promoting patient centered care and life-long health as well as wellness leading to a timely access of individualized care. These customer services remind the patients of their upcoming appointments and additional vital clinical reminders. These measures have resulted in reduction in spent in healthcare facility by allowing more patient-physician quality interaction. This is associated with high levels of patient satisfactions, care quality, fewer readmissions and fewer hospital stays. The facility is also involved in a number of Geriatric Research Education, Simulation Center, and mental illness research in order to improve quality of care (Pittsburg VA, 2013).

Erie VA medical Center and Federal Healthcare and Veterans Affairs Hospitals

Erie VA is committed to delivering quality care to patients as ever. The healthcare facility has put every measure to raise awareness on quality, safe and cost effective care to the veterans and their families. The primary care facility has revamped its care delivery process using Patient Aligned Care Team (PACT). Through these technological quality improvements, veterans and their relatives have more choices when it comes to where and how to receive their care through programmed primary care visits, Telehealth services and primary care services (Erie VA, 2011).

The healthcare facility utilized team based care, where teamlet (nurse, physician and technician) consistently provide comprehensive patient centered care. In addition, the utilization of PACT ensures continuity and coordination of care as well as patient satisfaction. An example of such includes integration of primary care and mental health which is aimed at improving patients emotional and physical needs are met in a seamless transition. Erie VA have stepped quality care further by completing the Specialty Care expansion which has provided additional specialty clinical services. Plans are underway to improve the facilities nutrition and food services, ambulatory surgery and behavioral health (Erie VA, 2011).

James E. Van Zandt VA Medical center and Federal Healthcare and Veterans Affairs Hospitals

This VA healthcare facility has undergone significant changes in the last few years with patient centered goals. A patient-centered strategy ensures that the healthcare providers establish an effective partnership with patients and to focus on the whole person instead of focusing on a health condition or disease. The healthcare facility quality improvement approaches that will improve quality care including Patient Aligned Care Teams (PACT) and integration of new and innovative technologies that facilitate efficient prevention initiatives and health promotion (James E. Van Zandt VA, 2011).

The healthcare providers in this healthcare facility have been trained on PACT practices and principles. These quality improvement measures has led to reduced wait times, increased patient satisfaction, and reduced cost of care and reduction of medication errors. The healthcare facility is expanding on the existing telehealth services to cover for behavioral, Nursing Education, homeless clinics, dermatology and nursing education. The healthcare facility is also aligning their telehealth services. The employees are trained on ways to improve and prevent diseases (James E. Van Zandt VA, 2011).

Lebanon VA Medics for Federal Healthcare and Veterans Affairs Hospitals

This healthcare facility provides quality and flexible quality care in for veterans and their relatives. Lebanon VA medical Center is one of the largest healthcare systems in the USA. The healthcare facility has integrated technology in its system which has improved communications between healthcare providers and service users. For instance, the use of information technology during delivery of care improves decision making process which in turn improves the efficiency and quality of care. Technology improves preventive diseases, frequency in screening, prescription and improved services such as computerized physician order entry (CPOE), which is associated with reduction in repeated procedures and tests, cost saving and less medication error (Lebanon VA,2014).

Integration of technology in this healthcare facility has also improved delivery of healthcare services such as proactive planning, post discharge follow-ups. The use of electronic records have improved patient satisfaction, patient-physician communication, reduction in waiting time and in comprehensive decision making processes. The main challenge in this healthcare facility is limited resource to cater for a large population of patients with dynamic needs. The healthcare facility is seeking new measures to eradicate this complication such as expanding the emergency department and surgical center and laboratory buildings in order to accommodate more patients and to avoid unnecessary delays (Lebanon VA, 2014).

Federal Healthcare and Veterans Affairs Hospitals in Beaver County CBOC

Beaver County CBOC healthcare facility provides primary care health care services including physical exams, radiology, dietary, podiatry and laboratory services. The healthcare mission is to improve the community’s health status by delivering safe, cost effective and quality care. The leaders in this healthcare facility have committed to raise quality of care by sharing evidence based practice and committing to quality improvements as well as promoting transparency in healthcare so that each time patients seeks medical services, they obtain the highest standards of care as much as possible. For instance, the healthcare facility provides coordinated care so as to reduce hospitalization days. The efficiency of inpatient resource utilization is measured by the number of hospitalization days, costs of emergency department visits, control of ancillary services such as unnecessary imaging and laboratory testing. These quality improvement measures has led to reduced wait times, increased patient satisfaction, and reduced cost of care and reduction of medication errors (Beaver County Outpatient Clinic, 2013).

One of the most challenges in this healthcare facility is eradication of readmissions. However, the healthcare facility continues to work on strategies to prevent unplanned readmission within 30 days. This remains an issue of concern due to patient inherent characteristics such as difficulty in understanding discharge instructions, poor support from patient’s relatives and care givers, medication non adherence among other factors. The healthcare facilities have expanded their knowledge base to establish strong relationship with their patients, peers and leaders in the healthcare facilities so as to coordinate care. The healthcare facility can integrate care by combining primary care appointments with comprehensive patient education, follow up calls, post-discharge call backs in order to ensure efficient exchange of information between healthcare providers and the patients (Beaver County Outpatient Clinic, 2013).

Federal Healthcare and Veterans Affairs Hospitals References

Pittsburg VA. (2013). VAPHS continuously improving. Retrieved from http://www.pittsburgh.va.gov/news/docs/2013-annual-report.pdf

James E. Van Zandt VA. ( 2011). Caring for Veterans of all generations. Retrieved from http://www.altoona.va.gov/docs/2011AR.pdf

Erie VA. ( 2011). Annual Report to the Community. Retrieved from http://www.erie.va.gov/news/newsrelease/ErieFY10Report.pdf

Lebanon VA. (2014). Report to the community. Retrieved from http://www.lebanon.va.gov/public_affairs/2014AnnualReport.pdf

Beaver County Outpatient Clinic. (2013). Quality healthcare system. Retrieved from http://www.pittsburgh.va.gov/locations/beaver.asp

Health Care Governing Board Case

Health Care Governing Board Case Order Instructions: health care case

part 1 #1-4

Sunshine Hospital is in need of major renovation of its electrical system. One of Sunshine’s governing board members, Willy Watt, is an electrical contractor who is a partial owner of an electrical restoration company. He would like to bid on the project. May he? If he does, what must he do? What must the governing board do? Is there a problem with Mr. Watt’s fiduciary duty? Is there a problem with the governing board’s fiduciary duty? What would you recommend?
Dr. Wilson is a gastroenterologist. As part of his informed consent, he includes an exculpatory contract that excuses him from liability in the event he commits an act of negligence. He will not operate on a patient unless they sign the contract. Dr. Wilson is the only gastroenterologist in a 50-mile radius. Are there any problems with Dr. Wilson’s contract? What do you expect a court to conclude if a patient does sue him for negligence after the patient has knowingly signed his contract?3. Which high-risk area associated with fraudulent billing practices do you think is the most problematic? Why?
Of the six steps for an effective compliance program, outlined in the following website, which step(s) do you think is/are the most important? Why?

Health Care Governing Board Case Sample Answer

Question 1: In my opinion, Mr. Willy Watt should not bid in order to avoid conflicts of an organization. The main responsibilities of the board of members are to ensure financial accountability of the healthcare organization. The Board members are the trustee’s of organization assets. If he must bid, the governing board must exempt him from fiduciary duty. There is no problem with governing boards fiduciary as long as they remain trustworthy, loyal and accountable. However, there would be an issue with Mr. Watt’s fiduciary duty because there is conflict on Mr. Watt’s loyalty and interest (Gannons Solicitor, 2013).

Question 2: Dr. Wilson the gastroenterologist actions are permitted expect in a situation where the healthcare providers acts are proven as gross negligence. There is problem’s with the contract unless he coerces a patient to sign his contract without the knowledge of the liability exemption clause. If a patient sues him for negligence, he cannot be accused because the patient signed the contract knowingly (AHIMA, 2013).

Question 3: The areas associated with high incidences with fraudulent billing practices that are problematic are up-coding, patient identification error, cloning, phantom billing, repeated billing and service fragmentation and unbundling (AHIMA, 2013).

Question 4: There are six tips that facilitate an effective compliance program. These include establishing a culture of compliance, outlining procedures, policies, training, and effective communication, establishing ca corrective system and performing audits. These tips are all important, but the most important one is training. This is because continuous training will help the staff understand the importance of providing a commitment plan with technical and monetary support. Through training, the staff will understand the policies and procedures specific to their job function. Training process provides an opportunity for interaction between the various departments (National Law Review, 2016).

Health Care Governing Board Case References

AHIMA. (2013). Integrity of the Healthcare Record : Best Practices for EHR documentation (2013 update). Retrieved from http://library.ahima.org/doc?oid=300257#.WDi_EFzuTIU

Gannons Solicitors. (2013). Director’s responsibilities and Fiduciary duties. Retrieved from http://www.gannons.co.uk/company/directors/directors-responsibilities-fiduciary-duties/

National Law Review. (2016). OIG Posts Tips for implementing an Effective compliance program. Retrieved from http://www.natlawreview.com/article/oig-posts-tips-implementing-effective-compliance-program

Introduction to the Healthcare Facility

Order Instructions:

The Session Long Project for this course is to evaluate and critique a health care facility you are familiar with and compare it to the general principles and standards for quality assurance presented in this course.

In the earlier modules, you identified a health care facility for the subject of the SLP and presented a description of the facility and its quality assurance program. You also critiqued the facility’s Continuous Quality Improvement program.

In this module, you will discuss and critique the subject facility’s Utilization Management program. The remaining modules for the Session Long Project the remaining tasks are as follows:

SLP Assignment Expectations

For this module, you are to complete the following tasks and to submit a 4- to 5-page paper. (This does not include the title or reference pages):
•Describe and discuss the facility’s Utilization Management program.
•Compare and critique the subject facility’s Utilization Management program to that of a model facility and whether the facility adheres to the recognized standard for utilization management, including utilization review and whether this review leads to improvement in the quality of care.
•Identify areas for improvement in the facility’s Utilization management program, if any, and any recommendations you think should be implemented to improve the quality of patient care.

Module Overview

Utilization Review (UR): A system designed to monitor the use of, or evaluate the medical appropriateness, efficacy or efficiency of health care services, procedures, providers or facilities. utilization review may include ambulatory review, case management, certification, concurrent review, discharge planning, prospective review, retrospective review or second opinions. NCGS 58-50-61(a)(17). (Refer to Glossary at http://www.nciom.org/hmoconguide/GLOSS31E.html)

Introduction

Utilization review is an important component of a quality assurance program. It is intended to monitor the care provided to patients and to detect patterns of over and underutilization. However, utilization review doesn’t stop at this point. It moves ahead by taking the utilization data and changing utilization practices among practitioners and providers to improve quality and promote effective utilization of medical resources.

In many medical facilities, utilization review extends to outpatient review services by reviewing requests for elective procedures and diagnostic testing. Utilization managers and staff will then work with the attending physicians to determine if clinical data support the benefits covered for the requests. In some medical facilities, this is called Demand Management.

Utilization review, or UR, as it is frequently called, was originally intended as a vehicle that addressed cost containment rather than the adequacy of patient care. Basically, UR is a cost containment technique.

UR can occur retrospectively or prospectively. When it is conducted retrospectively, it is primarily concerned with the review of services already rendered; however, when it is conducted prospectively it is used to authorize or refuse proposed treatments, referrals, and even hospital admissions. In the perspective mode, UR may have severe time restraints which if not met may cause harm to the patients. Medical conditions/diseases do not remain static during utilization review.

Another issue regarding UR is whether the employees or agents of a managed-care organization are practicing medicine when they make a determination whether a requested treatment is medically necessary.

Utilization review is an integral part of quality assurance. If managed properly it certainly can results in a higher quality of care while controlling costs. However, if and organizations’ utilization review program is inefficient and poorly managed it has the potential to harm patients and lower quality of care.

Required Reading

Anonymous. (2013). Does your organization have a utilization management committee? Medical Staff Briefing, 23(11), 1,3-5.

Frazier, K. (2014). Utilization Review Software: The Impact on Productivity and Structural Empowerment in Case Management Nurses in an Acute Care Setting. Gardner-Webb University.

Koike, A., Klap, R., & Unützer, J. (2014). Utilization management in a large managed behavioral health organization. Psychiatric Services.

Mullahy, C. M. (2014). The Case Manager’s Handbook, (5thed). Burlington, MA: Jones & Bartlett Learning. Retrieved from http://books.google.com/books?hl=en&lr=&id=iUPyAAAAQBAJ&oi=fnd&pg=PA12&dq=concurrent+utilization+review+programs+in+nursing+homes&ots=iorEmkFyuh&sig=4YnmC-9Hh6jCoi0rK2dH58NhoIM#v=onepage&q&f=false

NHS England provides funding for clinical utilization review programmes to improve patient flow. (2014). Professional Services Close – Up, Retrieved from http://search.proquest.com/docview/1518167158?accountid=28844

Olaniyan, O, Brown, I. L., & Williams, K. (2011). Concurrent utilization review; Getting it right. Physician Executive, 37(3), 50-54.

Plebani, M., Zaninotto, M., & Faggian, D. (2014). Utilization management: a European perspective. Clinica Chimica Acta, 427, 137-141.

Tubbs, S. L., Husby, B., & Jensen, L. (2011). Ten common misconceptions about continuous improvement efforts in healthcare organizations. The Business Review, Cambridge, 17(2), 21 – 28.

Sample Answer

Introduction to the healthcare facility

The healthcare facility identified is Durham Veterans Affair healthcare (VA) in North Carolina. The healthcare facility provides services to military members, their families, and the retired veterans. The services provided in this healthcare facility include primary care, surgical services, audiology, ophthalmology, inpatient services, and outpatient services. It also has other ancillary departments such as laboratory and radiology departments The department has operating rooms for regular surgical procedures, cytography and angiography. All the healthcare departments in this facility must follow quality assurance procedures established by its department (Durham.va, 2015).

Utilization Management Program

The VA Durham utilization program is design in a manner that ensures delivery of quality and cost effective care to the service user. The utilization program is under the administrative and clinical direction of the Medical advisory council and the Medical Advisory vice president. The Medical advisory council is mandated to evaluate and approve the utilization management program every year. In my place of work, the utilization program is manual. The overview of VA utilization management plan is a follows (Durham.va, 2015);

Referral system: All referrals are to be made by the Primary Care Physician (PCP) after consultation with a specialist at any time. However, no referrals are needed to treat emergency medical condition unless it puts the patient’s health in jeopardy, potential impairment of body functions and dysfunction of a body organ.

Tertiary plan care: All tertiary care plans should be reviewed on an individual basis based on the patients immediate medical need and its availability. The specialist final decision of referrals will be evaluated by the plan medical director.

Out-of-Plan Referrals: The requests of healthcare provider outside the health facility will be done on an individual basis based on the availability and patients needs unless the patient’s health status could be impacted negatively if out-of- plan referrals is denied.

Corporate Pre-service Review: Approval must be given before providing services. The main reason is to determine if the services is appropriate for the patient and the setting. Clinical information must be provided for all healthcare services that need clinical review. The Utilization Management staff should use plan documents to determine patient medical necessity coverage and determining their benefits. Clinical information needed for clinical review should be provided on the appropriate date and time. The clinical information must contain patient name, history of presenting disease, diagnostic results and the patient’s response to current treatment.

Inpatient review: The staff assigned to follow member at the acute care facility should collaborate with the facility healthcare providers so as to ensure ca continuum of care. The facility staff and utilization management’s clinical staff will work in coordination to ensure that member’s discharge needs are met. All inpatient should be reviewed before their admission to ensure that they have appropriate and adequate services according to pre-established medical necessity and benefits determinants. The admission will be approved accordingly of rescheduled in appropriate timing and setting.

Concurrent review: The ongoing patient care will be reviewed and evaluated based on patients specific needs and pre-established medical necessity. Discharge planning can begin at this time so as to plan for continuing quality care even after the patient is discharged.

Retrospective review: is performed after discharging the patient from a healthcare facility. This should be implemented at when so as to monitor a patient’s progress after the patient was discharged when a physician was unavailable or when the healthcare facility fails to demonstrate that the patient condition meet criteria for a patient stay.

Discharge planning: the utilization manager coordinator will monitor the ongoing needs for the patient after discharge. Few days after discharge, follow up phone calls should be done so as to identify members at high risk of becoming admitted. This is to ensure that the quality assurance is complied to and to assist in care coordination so as to mitigate adverse outcomes.

Denials and Appeals: All denials will be given by the physician and must state the denial reason and contact information to discuss the denial. A written denial will be written and emailed to the Utilization management committee.

Critique of VA utilization management program

The main challenge of VA utilization program at my work place is that it is an expensive manual resource that fails to engage the providers adequately, and often results into inefficient service for the service users (Anonymous, 2013). For instance, 90% of pre-authorizations need phone communications, which is time consuming and costs up to $50-$80 costs per each authorization. In addition, it is estimated that about 15% of medical care procedures are unnecessary such as duplicative tests and hospitalizations.

Most of these costs are attributable to inconsistencies observed during clinical decision making that occur when relying on the traditional manual utilization management processes and the incomplete coverage as necessary. In addition, when healthcare providers have to wait until healthcare is delivered to deliberate on the event, it leads to missing of opportunities that will ensure cost effective quality care. In addition, the pre-authorization process that follows manual process requires a great deal of investment as compared to an automated system that facilitates immediate approvals upon request, and to providers with appropriate guidance based on evidence based practice (Mullahy, 2014).

Areas for improvement in Utilization Management program

Some utilization management program changes will occur in the VA utilization program. The driving force for most of these changes includes advancement in organizational relationships and utilization management technologies. Effective utilization management is based on its ability to provide detailed yet coherent clinical information, and in providing clinical guidelines that define the most effective and appropriate care that will ensure positive patient outcomes (Mullahy, 2014).

As aforementioned, the VA programs are severely constrained due to inadequate information to support informed and appropriate care to a current diverse cohort of patients. The VA Utilization Management program should be transparent enough to ensure that the health providers and service users reach their decisions by eliminating contention and improving optimized decision making processes that put into consideration patient’s preferences (Frazier, 2014).

The utilization management program should be designed to ensure that it s actionable. This implies that the plan recognizes its implication and automatically provides specific guidance based on evidence based clinical guidelines. The plan should deliver relevant information in real time so as to ensure that smooth quality workflow is sustained. This includes automating workflows so as to shorten the path to seek approval, providing rapid response and lowering administrative burden in most of pthe atients, and simultaneously allowing the clinicians to focus on complex “exceptions” that truly needs their concentration and expertise (Koike, Klap, & Unatzer, 2014).

This implies that it is time to rely on innovate technology that suit the VA health care facility missions and vision. It is important to work on these decision support solutions so as to help the healthcare systems to provide value based care. This is process requires collaborative efforts between the healthcare providers so as to make it a reality.

References

Durham.va (2015). Durham VA medical Center: Retrieved from http://www.durham.va.gov/

Anonymous. (2013). Does your organization have a utilization management committee? Medical Staff Briefing, 23(11), 1,3-5.

Frazier, K. (2014). Utilization Review Software: The Impact on Productivity and Structural Empowerment in Case Management Nurses in an Acute Care Setting. Gardner-Webb University.

Koike, A., Klap, R., & Unatzer, J. (2014). Utilization management in a large managed behavioral health organization. Psychiatric Services.

Mullahy, C. M. (2014). The Case Manager’s Handbook, (5thed). Burlington, MA: Jones & Bartlett Learning. Retrieved from http://books.google.com/books?hl=en&lr=&id=iUPyAAAAQBAJ&oi=fnd&pg=PA12&dq=concurrent+utilization+review+programs+in+nursing+homes&ots=iorEmkFyuh&sig=4YnmC-9Hh6jCoi0rK2dH58NhoIM#v=onepage&q&f=false

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