NUTR370

Overview of Health Care Systems
Outpatient–> Inpatient–> Outpatient
Shift to a shorter inpatient stay and more outpatient services
Golden Triad of Health Care
Cost- U.S. spends more GDP on healthcare
Access- U.S. has fewer physicians, hospital beds, physicians visits, and hospitalizations
Quality- Americans only receive 55%-70% of healthcare they need and large disparities exist in health outcomes by insurance status, race, income, and location
Primary concerns of health care systems
Primary care crisis
Shortages
Financial challenges
Health care reform
Patient safety and quality
Governmental mandates
How much money is spent per person per year on healthcare?
$9,000
Organizational structure of a hospital
Board of Directors/Trustees
Administrative services
Therapeutic services
Diagnostic services
Informational services
Support services
Committees
Inpatient
Patient admitted and stays for at least one night (16% of RDNs)
Outpatient/ambulatory care
Patient receives medical care without staying overnight (8% of RDNs)
How is the trend toward increased outpatient services likely to affect healthcare?
Increase in preventive services
Strong financial incentive
Long term care
Extended medical and social services required by people with chronic conditions
Acute care
Happens over a short period of time
Complementary and alternative care
Complementary (used with conventional medicine) or alternative (used in place of conventional medicine)
CAM is in outpatient settings and is usually out of pocket
Telemedicine
Use of informational technologies in order to provide clinical health care at a distance
Patient Centered Medical Homes (PCMH)
Model of delivering and financing healthcare by creating a single center through which all of a patient’s care is coordinated with bundled payments
What is the idea behind PCMHs?
All inclusive care can be more efficient and of better quality
Purpose of Accountable Care Organizations
Create medical neighborhoods
Primary Care
Healthcare at a basic rather than specialized level for people making an initial approach for treatment
Concerns for provision of Primary Care
Costs could rise without it
People may not be able to access healthcare easily
Quality of care may not be as high
What practice area in Dietetics employs the largest number of individuals?
Clinical practice
Expanding areas in nutrition
Obesity and weight management
Aging
Food supply safety
Human genome and genetics
Route to become and RD
Complete DPD
Get Verification statement
Complete Internship
Pass RD Exam
DPD
Didactic Program in Dietetics
Verification Statement
Official document that signifies student has met all academic and professional requirements dictated by ACEND
When can you apply for a dietetic internship?
Once you complete a DPD program
What three practice areas are required to be covered in all dietetics internships?
Nutrition therapy
Community
Foodservice systems management
Process to become a DTR/NDTR
Graduate of DPD program OR takes course work for DT plus 450 hours of supervised practice
Pass national exam for Dietetic Technicians after graduation
When are you eligible to take the DTR/NDTR exam?
After completing a DPD program
Nutritionist
Lacks recognized credentials and are un-qualified
Dietitian
Qualified to provide medical nutrition therapy or clinical nutrition consultations in either an individual or group setting
Types of work in consultation and business
Private practice, consultant-communications, public relations, research and development
Types of work in community based care
WIC, cooperative extension, public health, school/child care, food banks, sustainable nutrition
Types of work in education and research
University faculty, clinical research, DPD director, internship director
Types of work in food industry
National Dairy Council, Kraft foods
Types of work in nutrition educaton
Instruct participants on nutrition and diet, cooking, purchasing of health foods
Types of work in retail
Giant, produce/grocery managers, cooking coach specialist
Types of work in schools
School food service manaer
Types of work in public health
Certified health education specialist
Name of alumni group associated with nutrition department at PSU
NDAS- Nutrition and Dietetics Alumni Association
Who is a part of the traditional health care team?
Doctor
Nurse
Pharmacist
How are healthcare teams evolving?
More inter-professional healthcare teams that work together
Scope of Practice
Regulates what healthcare professionals can and cannot do
Who defines Scope of Practice?
States
Organization responsible for assuring the value of RD credential?
Commission on Dietetic Regulation
Valid nutrition credentials other than RD
Certified Nutrition Specialist
Board Certified Specialist in Sports Dietetics
What is a certification? An example?
Formal recognition of competence from a nongovernmental, national professional organization, demonstrates proficiency in a specialty area
Certified Diabetes Educator
What is accreditation?
Gaining formal outside approval by an accrediting agency
Accreditation at university level and health care setting
University level- educational programs
Healthcare setting- Hospitals
Two primary Health Care Accrediting agencies
JCAHO- Joint Commission on Accreditation of Healthcare Organizations
NCQA- National Committee on Quality Assurance
Core principles of medical ethics
Provide competent medical care with compassion and respect
Uphold standards of professionalism
Respect the law
Respect rights of patients, colleagues, and other health professionals
Continue to study, apply, and advance knowledge
Be free to choose whom to serve
Recognize responsibility to participate in activities contributing to community
Regard responsibility for patient
Support access to medical care for all people
Basic considerations in most medical codes of ethics
Autonomy
Justice
Dignity
Truthfulness and Honesty
Autonomy
Patient has right to refuse or choose their treatment
Justice
Concerns the distribution of scarce resources
Dignity
Patient, and person treating patient, has right to be treated with dignity
Truthfulness and honesty
Patient has free and informed consent
Function and purpose of ADA/AND medical code of ethics
Protect the profession and the credential, influence public and private policy, improve professional practice, educate practitioners about ethical decision making
Who can make ethics complaints?
Any member or non-member
Process that occurs once a complaint is made
If a complaint is made, it’s forwarded to a member for response
Ethics committee reviews complaint and discusses the response in executive session