Health Service Delivery in the US

2015 PM 508 Midterm Review

ANGELA REYES







CONTENTS

1.
2.
3.
4.
5.
6.
7.

Overview & History

Structure of American Healthcare System & Health of the US Population
Health Policy
Health Insurance
Health Care Finance & the Cost of Care
Health Reform: Models & Solutions, the ACA
Healthcare Delivery System Models & Innovation

Week 2 | STRUCTURE of AMERICAN HEALTH CARE SYSTEM & HEALTH of the US POPULATION
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Major components of the US health care system: describe the fx of each (PAILAA)
o Public Health global, national, state, local
FX monitor health, enforce laws, develop poliies, research, inform, educate, evaluate, mobilize
community partnerships
o Ambulatory Care ER, primary care (preventive included), secondary/specialty
Includes alternative/non-western/traditional svs like herbalists, acupuncture, traditional healers, illegal
pharmacies
o Inpatient Care (hospitals) secondary and tertiary care
Specialty, public/non-profit, limited scope of practice, short stay
o Long-Term Care skilled nursing, rehabilitation, home care, board and care
o Ancillary Care PT/OT, specialized services (dialysis), hospice, palliative (improve QOL for those with lifethreatening diseases)
o Auxiliary Care dental/mental health
Positive/negative characteristics of the US health care system
o Positive
Leads in medical technology, training, research
Sophisticated institutions and products
o Negative
Characterized by political climate
High spending based on volume, not quality
Little competition btwn insurers
Not focused on needs of pts, but on providers
Few cost-containment tools other than denial
Little emphasis on prevention
Based on FFS systems
Each physician svc is assigned a relative value based on the presumed resource costs of
performing that service
How would you describe the general health status trends of the past 50 years?
o Life expectancy increased due to decreased infant mortality
o Leading causes of death decreasing rates overall except resp disease
1999-2007 <3 disease, cancer, stroke, chronic lower resp disease
2008-2009 -- <3 disease, cancer, chronic lower resp disease, stroke
Major contributors: tobacco, diet/activity patterns, alcohol
What are some disparities experienced by US minorities?
o Highest uninsured Latinos
o Cost Barrier to accessing care Latinos highest, then African Americans
o Highest % of Low Birth Weights Blacks
o Mammogram rates for women 40+ years old greatest in whites, lowest in Hispanics
How would you define social determinants of health? Factors that contribute to overall health of a person: Health care
access, genetics, behaviors, environment, SES
o How do these determinants affect the social gradient in morbidity and mortality

Health-wealth gradient at all levels

Those at the bottom are more disempowered, get sick more often, and die sooner.

Leading to premature death: lifestyle/behavior, genetics, social/environmental factors, then medical

care

What is the triple aim as discussed in Berwicks article?

o 1) Improving the experiences of patients (Quality)
licensing of professionals
high reimbursement
high availability to technology
o 2) Improving pop health
o 3) Reducing per capita costs
coordinated care, preventive medicine, having budget
DRG as it pertains to Medicare
o Care improvement efforts: safety, effectiveness, patient-centeredness, timeliness, efficiency, equity
Describe the difference between the pop health and the medical model
o MEDICAL
Focus on individual, factor linked to specific disease
Reactive, responds to abnormality, disease, or injury
o POPULATION
Determinants of health assessed in combination
Including social/economic environment, physical environment, genetics, medical care, healthrelated
What is the challenge of applying the pop health model to an illness?
o Care may need to be tailored to individual based on current physiological wellness
o May need to consider medical/family hx and tests

Week 3 | HEALTH POLICY

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Why is it important for the government to set policies on health care?

o Helps shape social norms; empowers people and orgs; bring about changes in systems and financing,
translates programs/interventions to laws and regulations
What processes makeup a policy cycle and who are the key stakeholders?
o The formation and implementation of health policy occurs in policy cycle comprising of:
Issue raising
Policy design
Public support building
Legislative decision making and policy support building
Legislative decision making and policy implementation
What are some examples of health policy initiatives or regulations that have focused on access to care, quality of care,
and cost of care?
o Access to Care ACA, patient access to providers via email meaningful use EHR to increase transparency and
patient access
o Quality of Care licensing of providers, high reimbursement, high availability to technology

o Cost of Care coordinated care, preventive medicine, having budget

DRG (dx related group) as it pertains to Medicare
Be able to ID the federal health agencies and their roles
o USPHS (US Public Health Svc)
o CDC (Centers for Disease Control and Prevention)
o NIH (National Institutes of Health)
o HRSA (Health Resources and Services Admin)
o These agencies implement health policy
Regulation, issue guidance or grant announcements, set rules and standards for implementation
policy, can affect policy (modification)
What are the roles of the state & local governments in shaping health policy?
o STATE
Similar to federal policy making
State agencies
State budget processes
State referendums represent difficult issues initiatives take it to the ppl
Voting on propositions
o LOCAL (counties & cities)
Run local PH programs, public hospitals/health centers
Why is it important to consider politics and interest groups in the policy making process?
o Policies are decisions, agreed upon or legally binding set of actions or guidelines
o Politics are how ppl react to those policies, in their formation or implementation.
o Interest groups have influence of money
How do uncertainty and information asymmetries interfere with achieving a competitive health care market?
o Information transparency is goal for govt policy so that producers and consumers have sufficient knowledge to
make informed choices
o In competitive market, efficiency measures whether resources are being used to get the best value for money
o Needs of health care is unpredictable competition doesnt lead to appropriate level of expenditure
o Random illness may strike; consumer may not understand medical intervention
o Same info not available to all parties
Providers know more than consumers; consumers know more than insurer
o Provider-Induced Demand: pt tends to listen to provider prescribes test/meds/tx
There could be more tx than needed
What are some examples of governments remedy to market failure in health care?
o Response to excessive-tx: Prior authorization/utilization review but may limit quality of care
o Response to Moral hazard bc ppl dont pay full costs of care, they are less price-sensitive: Cost-Sharing but
may change consumers behavior to reducing potential costs
o Response to pharma/biotech/DME: govt FDA approval required based on safety/medical effectiveness, not
costs nor cost effectiveness
Explain the anti-trust law and how it is applied to health care.
o Promotes competition with idea that economy fxs best when markets thrive prevent monopoly
Problem with healthcare: may not have completion within a given region

Problems arise when competitors jointly use info to attempt to control the price within the a specific
geographic and product market
What really happens: DECREASE in COMPETITION
Increasing # hospital mergers, info sharing among providers
Antitrust law cannot force competition when few competitors exist
What is the relationship between the issue of equity and government policies?
o Typically trade-off btwn generating efficient market outcome (generating the biggest exonomic pie possible)
and increasing equity (giving everyone and equal slice of the pie)
o Think about how redistribution policies apply to health care.
Some policies more efficient than others
i.e. giving set amts of $$ for specific assistantce like housing and insurance coverage VERSUS giving
same amt of $$ as cash subsidy and leaving it to the individual to use the money correctly

Week 4 | HEALTH INSURANCE

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Why is there a demand for health insurance?

o Care = $$$, people are generally risk averse (willing to pay a little to protect assests)
Why would you expect more people to purchase insurance against losses associated with hospital care than dental care?
o Yes, bc hospital is more $$$. When go to hospital, usually NEED the care
o VARIANCE OF RISK
o DEMAND ELASTICITY -What % of US pop have employer sponsored insurance? ~55%
What is the basic structure of a HMO plan? HEALTH MAINTENANCE ORGANIZATION
o Covers only care provided by in-network providers and hospitals
o Need REFERRALS from PCP to see specialist
o Provides needs of enrolled pts for fixed/monthly/pre-paid fee or capitation
What is the basic structure of a PPO plan? PREFERRED PROVIDER ORGANIZATION
o Network of providers who render svcs at predetermined negotiated fees (FFS)
o Enrollees have incentives to use network, but can go out of network for higher costs
o DO NOT need referral to see specialist
What is a Point-Of-Service? (POS)
o Hybrid of HMO/PPO
o May still need referral to see specialist
o May have coverage for out-of-network, though with higher sharing cost
What is insurance premium, co-insurance, co-payment, and deductible?
o UNDERWRITING before ACA, individuals subject to this look at previous medical hx before setting premium
o CO-INSURANCE -- % of costs a premium holder pays
o CO-PAYMENTS what consumer pays towards a svc usually goes towards deductible
Affects out-patient utilization bc you have to pay every time you see the DR
o DEDUCTIBLES what premium holders pay before insurance kicks in
Describe moral hazard and adverse selection as they relate to health insurance
o MORAL HAZARD tendency to use benefits even if they are not needed
Going to ER to get Tylenol (for free) vs going to the drug store to buy it

Once person is insured, person is more likely to demand health care bc it may not cost them extra to
use the svcs
Cost-sharing deductibles but dont want to do this for preventive svcs
HMOs stay w/in network
o ADVERSE SELECTION reducing risk to limit liability by selecting only relatively healthy people
May have occurred when consumer subject to underwriting when applying for health insurance
Refers to situation when individuals who are likely to use more health care svcs than others, due to poor
health, enroll in health insurance plans in greater numbers
WHY IS THIS AN ISSUE IN EXPANDING COVERAGE? $$$
o IMPORTANT INSURANCE CONCEPTS TO CONSIDER IN REFORM
Portability take pre-existing conditions with you HIPAA
Guaranteed issue plans prohibited from exclusion sbased on health status/pre-existing conditions
Mandates individual/employer mandates to health insurance
Reinsurance limits losses beyond specified limit
ACA temporarily provides payment to plans that enroll higher coast individuals (only until
2016)
What is the difference between fee-for-service and capitation payments?
o CAPITATION providers given (x) amt of $ per svc per member
Leftover $ not used up goes to provider as profit
What is prospective payment system in Medicare? changed the way hospitals were reimbursed
o Payment amts are set based on diagnosis at admission (DRG)
o Pay hospital for per case baseis, not per item/svc
o Govt reimburses the hospital based on a pre-set amt for a particular diagnosis
What are Diagnosis Related Groups (DRG)?
o A bundle of services relating to a particular diagnosis, such as that for knee surgery
o Method of reimbursement established under Medicare
o Hospital receives same amt no matter whats done to the patient at the hospital
Weighted by geographic location, # of low-income pts in location, whether facility is a teaching facility
Health Insurance Premium = healthcare expenditures (medical claims) + loading charges (administrative
marketing profits)

Medicare vs Medicaid: Which plan covers what? Eligibility?

POPULATION
RUN BY

Overview

Eligibility
Requirements

MEDICAID (Medi-Cal)

MEDICARE

Covers health care costs for the poor

Federal program administered by the states
Medicaid in the U.S. is an assistance program
that covers the medical costs of low- to no-
income families and individuals. Children are
more likely than adults to be eligible for
coverage.
Strict income requirements related to Federal
Poverty Level (FPL). With expansion under the
Affordable Care Act, 26 states cover at or
below 138% of FPL. States that opted out have
a variety of income requirements.

Long-term care for elderly

Federal program with uniform, national rules
Medicare in the U.S. is an insurance program
that primarily covers seniors ages 65 and older
and disabled individuals of any age who qualify
for Social Security. Also covers those of any age
with end-stage renal disease.
Regardless of income, anyone turning 65 can
enroll in Medicare so long as they paid into
Medicare / Social Security funds. People of any
age with severe disabilities and end-stage renal
disease are also eligible.
Routine and emergency care, hospice, family
planning, some substance and smoking
cessation programs. Limited dental and vision.

Part A copayments for lengthy hospitalizations
(no out-of-pocket max, except for Medicare
Advantage)
Part B for 2011, there is a coverage gap such
that Medicare will not cover total drug costs
after they exceed $2840, but will resume
coverage once total drug costs reach $4550
Beneficiaries must also pay a monthly premium
and 25% of drug costs once the deductible is
met.
Part A costs nothing for those who paid
Medicare taxes for 10 years or more (or had a
spouse who did). Part B in 2014 costs
$104.90/mo for most. Part D costs vary, usually
around $30/mo. Medicare Advantage costs vary.

Services
Covered

Children more likely to have comprehensive

coverage in all states than adults. Routine and
emergency care, family planning, hospice,
some substance and smoking cessation
programs. Limited dental and vision.

Sometimes charges FFS. Medicaid will often
pay for Medicare deductibles and premiums,
and it can cover the 20% medical costs that
Medicare will not pay for.

Cost to
Enrollees

Varies by state, with some imposing

deductibles. Usually low, but much may
depend on what little income one has.

Governance

Funding

Jointly governed by the federal and state

governments. Affordable Care Act sought to
make more Medicaid rules universal, but the
Supreme Court ruled states could opt out.
Variety of taxes, but most funding (~57%)
comes from federal government. Sometimes
hospitals are taxed at the state level. Along
with Medicare, Medicaid accounts for roughly
25% of federal budget.

Entirely governed by the federal government.

Payroll taxes (namely, Medicare and Social
Security taxes), interest earned on trust fund
investments, and Medicare premiums. Along
with Medicaid, Medicare accounts for roughly
25% of federal budget.

User
Satisfaction

Relatively high

High

Populations
Covered

All states, D.C., territories, Native American

reservations. Around 20% of population on
Medicaid. 40% of all childbirths covered by it.
Half of all regular AIDS/HIV patients.

All states, D.C., U.S. territories, Native American

reservations. Around 15% of population on
Medicare.

Mostly children enrolled, but most of the costs
attributed to elderly and disabled.

o Medicare Part C = Medicare Advantage Plan

Like HMP/PPO
Offered by private companies approved by Medicare (i.e. SCAN)
Will provide all of Parts A&B; May offer extra coverage such as vision, dental, wellness programs
Most include Part D
Some have high deductibles while others have none copays and co-insurance can vary as well.
Describe what is Medicare doughnut hole
o For those enfolled in Medicare Part D, this occurs after they and their plan spend a certain amt of $ for covered
drugs, but before they hit catastrophic coverage in which they are only responsible for a small percent of their
drug costs
o Coverage gap in between initial coverage period and catastrophic coverage (upon which Medicare pays 80%)

Week 5 | HEALTH CARE FINANCE & the COST OF CARE

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Describe the US health care spending in the past 2 decades in terms of $, per capital spending, and share of GDP
o Has increased almost doubled in the past 10 years
o Share of GDP has increased steadily, but still increasing
The more we spend on health care, the LESS we allocate to other resources such as education
Heavily relies on private insurances diff reimbursement/incentive suystems compared with other
countries
What segment of the US population accounts for majority of our health care dollars?
o Elderly! especially in last year of life
Why are health care costs increasing?
o Main reason is technology.
o Other cost drivers: increase in inflation, pop changes (more elderly ppl), increasing complexity in administering
a multi-payer system, fraud/abuse, malpractice, emphasis not curative rather than preventive
What implication does rising health care spending have on the government, employers, and individuals?
o Affordability for govt -- @ current growth rates, spending will exceed revenue
o Affordability for employers employer-sponsored insurance offer rates have dropped steadily over the last
decade
o Affordability for individuals growth rate of insurance premiums has exceeded that of workers earnings for
many years
o Health implications for individuals
Understand geographic variations in health care and what happened in McAllen Texas.
o Spending not univorm across the county
o Utilization of care is what leads to overall variations in spending
Over-utilization in McAllen Texas. Practice was unaware of high spending costs
o On AVG, expensive regions have sicker patients ppl more likely to be dx with a disease when their
doctor/hospital treats them mre intensively
This BIAS makes pts in high-intensity areas appear sicker than they really are
How can we hold down costs and what are some ideas for controlling costs?
o Change payment to prepaid

o Value-Based Purchasing: changing the way we pay for care. From doing things to achieving outcomes
(quality)
o Wage & price control / controlling supply
o Competition
o More transparency in pricing
What is pay-for-performance and its significance?
o Payment based on quality outcome
o Changes incentives
o Integration of svcs and bundling of payments
o Penalties for mistakes (no payment for readmissions or svcs resulting in medical errors)
Issues: adverse selection, fraud and other disclosure issues, measurement and reporting

Week 6 | HEALTH REFORM: MODELS & SOLUTIONS, the ACA

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Describe the uninsured population in terms of income, employment status, age, and health status
o Age: mostly mid 20s mid 30s; other than elderly
o Income: mostly below 138% of the Federal Poverty Level (~$24,000 for fam of 4)
o Family Work Status most are employed @ least 1 full-time working adult. Affordability may have to do with
it
o Health Status uninsured 1/3 say fair to poor health, less say they have ongoing condition compared to
insured, and less take prescriptions than insured
o Race mostly hispanics
Understand the main components of the ACA
What is the current state of the ACA (enrollment, implementation of the provisions)
o Many experienced difficulty in applying, assembling paperwork, and even finding out how to apply
o Of those uninsured, the tried to apply more than 1 way, tried to sign up on the website, walled a toll-free
number, and visited Medicaid agency
o Awareness lags behind favorability for most ACA provisions
What is employer mandate?
o 100 or more full-time employees must offer coverage to up to 95% of all FT employees and dependents to age
26
95% due to flexibility for probationary period before benefits kick in
o in 2016, if 50-99 FT employees, must offer coverage to 95% FT employees and their dependents up to age 26
What is Medicaid expansion?
o As part of the ACA, it was expected to expand coverage to which population?
To adults who make less than 133% of FPL states can opt-out of expansion
1/3 of states chose to expand
o What is the controversy?
Federal govt will fund vast majority of expansion costs, but only until a certain time
But ppl who earn less than 100% of the FPL will still be ineligible for tax credits to purchase health
insurance large gaps in coverage available for adults
o States not moving fwd with expansion WOULD HAVE experienced the largest reduction in uninsured
Even with the implementation of the ACA, which groups will remain uninsured?

o Undocumented people
Not allowed to purchase private health insurance at full cost in state insurance exchanges
Eligible for ER care; non-emergency svcs at community health centers

Week 7 | HEALTH CARE DELIVERY SYSTEM MODELS & INNOVATION

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Why is it particularly important to have an integrated delivery system when caring for individuals with chronic
conditions?
o Coordinated care may need to see multiple specialists. To avoid extra costs, providers need to communicate to
about redundant tests/procedures.
What is care management or disease management?
o To reduce cost and promote more communication between providers for proper/efficient/quality care
o Usually telephone based collaborative team
o Self-management and advocacy
o Improves care coordination and health outcomes
What payment system changes (as we move away from FFS) are occurring along with the emphasis on integrated
delivery system models?
o Bundled payments hospitals and other grps have to work together bc payments come from the same sum of
$$$
o Episode-of-care-based payments
o Create incentives to keep people well (from coming back)
What are the important components of the PCMH (patient-centered medical home) model?
o Personal Clinician
o Physician-directed team oriented medical practice
o Whole-person orientation (patient-centered)
o Care is coordinated & integrated
o Emphasis on safety and quality
o Enhanced access
o Payment reform
o 1 enhance access and continuity of care
o 2 ID and manage patient populations
o 3 plan and manage care
o 4 provide self-care support and community resources
o 5 track and coordinate care (follow-up)
o 6 MEASURE and improve performance
How is ACO different from managed care of the past?
o Past Managed Care provider incentives not there no recognition for quality or efficiency, reducing costis
not sustainable solution, incentives dont promote long-term system approach, current delivery system does not
work together to offer optimal patient care
o ACO (Accountable Care Orgs): multi-specialty groups and integrated delivery systems; based on primary
care principles; health info technology; usually aligned with hospital; payment reform/shared savings/risk;
more population health focus

Focus on reducing per-member cost

Focus on taking care of the 10% of the pts who take up 2/3 of the cost
Why are enrollment size and experience important to ACOs success?
o To achieve sufficient savings to spread overhead and related costs
o Agreeing on a common set of cost and quality measure and thresholds, across payer contracts so need to
meet a threshold of enrollees

TRIPLE AIM
- Improve Quality and patient experience
- Reduce cost constrain health care cost growth
o Increase palliative care programs to improve quality of care and lower costs for late stages of serious illness
need media & consumer support
- Improve population health
Week 8 | INTERNATIONAL COMPARISON
- How is health care financed and delivered in Canada? Germany? UK?
o Canada -- govt finances through taxes; services provided by private providers
o UK govt manages infrastructure for delivery (medical institutions; providers are govt employees)
o Germany govt-mandated contributions by employers; delivery by private providers; sickness funds (non-profit
insurance companies) govt exercises all control
- CANADA
o Natl spending for health care maintained at 9-10% of GDP
o Budget for physician fees negotiated btwn govt and physicians
- US
o Natl spending for health care increased from <12% to 18%
o Health care = commodity to be distributed according to ability to pay
o Relatively minimal role in guiding our health system
o No uniform standard of care, and quality of care received often reflects the ability to pay
- What factors account for the higher health care spending in US compared to other developed countries?
o Rise in chronic diseases accounts for over 75% of healthcare spending greater use of technology
Rapid rate of adoption of technology high use of imaging technologies
- Is quality of care better in US than other developed countries? Explain
o Overall, US health ranking among lowest in terms of health outcomes in relationship to spending
- What advancement does US show in health care compared to other developed countries?
o Use of newer technologies
Week 9 | PUBLIC HEALTH
- Organized community effort to prevent disease and promote health
o Protect health by preventing disease, promoting good health, keeping environment clean/safe
o Addresses the broader determinants of health like social determinants
o Important for surveillance, population based, education and policy
- Primary prevention prevent disease before it even occurs (seatbelts, helmets, immunizations)

Secondary Prevention reduce impact of disease that has already occurred (screenings)
Tertiary Prevention soften impact of ongoing illness (prosthesis,
PH Agencies: CDC, CDPH, LA County PH, local and state health depts., water districts, air quality boards, housing
agencies
o Responsibilities include surveillance, provide info/resources, health stats, standards in research, training,
primary care
Describe 3 core fxs of PH and corresponding activities
o Assessment monitor health of pops at risk to ID health problems and priorities / surveillance (reportable
diseases, lab services)
o Policy development form policies that inform/educate/empower people about health issues
Bill on posting food calories / cleaning up vacant lots reduced gun crime in Pennsylvania
o Assurance assure all pops have access to appropriate/cost-effective care
enforce laws/regulations that protect health and ensure safety sanitary codes, immunizations, tobacco
control, STD testing

Week 11 | SAFETY NET/HEALTH DISPARITIES

- What is the health care safety net? (who they serve / providers / describe setting / mission stmt)
o Providers who care for low income, uninsured pop who have limited access to private health care
o Include public and other hospitals serving poor, outpatient clinics, private community clinics
o Dont turn away anyone (except for capacity)
- What are public hospitals and who do they serve?
o Serve everyone, including low income and uninsured
- Who is served by federally supported community health ctrs and the types of services they provide
o Low income, Medicaid, uninsured, vulnerable populations (jail inmates, those with disabilities, homeless, foster
kids, those with mental illness)
- section17000 of the CA Welfare and Institutions code
o mandates that counties are required to provide for health/welfare of their indigent pop
- How are safety nets financed?
o Medicaid and CHIP, Federally Qualified Health Center Funding (FCHQ cost-based reimbursement), Community
Health Ctr, State/local general fund support
- Disproportionate Share Hospitals (DSH)
o serves a significantly disproportionate number of low-income patients and receive payments form the
Centers of Medicaid and Medicare Svcs to cover the costs of providing care to uninsured pts
- What are the issues facing safety net providers in terms of their challenges?
o All comers cannot cherry pick
o Less flexibility, political concerns, govt restrictions
o Insufficient funding
o Patient base = vulnerable pops, low income, uninsured, with co-morbidity/social problems that contribute
to/exacerbate medical problems
- As more people gain insurance with health care reform, are safety nets still needed? What are some arguments for or
against continuing to fund safety nets?
o Yes, bc there are still the uninsurable due to lack of documentation that arent covered under ACA

Week 12 | PALLIATIVE CARE : approach that improves the quality of life of pts and their families when facing problems
associated with life-threatening illness through prevention and relief of suffering
- Difference btwn Palliative Care and Hospice Care
o Palliative Care presentation of life-threatening illness until death // multidisciplinary care provided to pts with
serious or life threatening illness that focuses on physical, psychosocial, and spiritual symptoms of relief of
suffering
o Hospice Care end-of-life care (6 months till death + bereavement care)
- Palliative care is NOT
o Giving up/losing hope
o Accelerating death
o In place of curative or life-prolonging treatment
o Same as hospice
- How is the new model of palliative care different from the old model of palliative care?
o OLD Cure-Care Model // palliative care, then hospice care until death
o NEW Continuum of Care // palliative care up to death and extending into bereavement care
- What results have studies shown about familys experience with palliative care?
o Longer survival
o Satisfaction: control of pain / non-pain symptoms / quality of life / support of family stress
- What results have studies shown about familys experience with palliative care? What do family caregivers want?
o Matches patient and family wishes; pain and symptom control, avoid inappropriate prolongation of the dying
process, achieve a sense of control, relieve burdens on family, strengthen relationships with loved ones
- Why is it important to ask the patients with serious illness about what they want from their health care?
o Clarifies goals of care with pts and families
o Assists with decisions to leave the hospital/withhold/withraw treatments that dont help to meet their goals
o Helps families select medical tx and care settings that meet their goals
- Describe the familys satisfaction with care when a family members last place of care was a hospital
- Why is palliative care a clinical imperative?
o Theres better quality of care for persons with serious and complex illnesses
o early palliative care starting at diagnosis improved QOL, fewer depressive symptoms, longer survival
- What services are included in long-term care?
o Physical
o Social
o Spiritual
o Psychological
- Who are most likely to need long-term care?
o Those with multiple chronic conditions