Sarah Michelle page 234 – 256 Study Guide

what is the strongest, gold standard hierarchy of evidence? - Meta analysis or systematic review (pull several studies that have already been done) what is the middle hiearchy of evidence? - randomized control trials, cohort studies, case control studies, cross sectional studies (all the C's - actual research) what is the lowest level of hiearchy of evidence? - editorials and opinions (no real research) - longitudinal/retrospective what is the difference between Quasi experimental design vs randomized control trial - both are middle levels of evidence Quasi - no randomization Random - is randomization of who gets placebo vs actual tx what explains and predicts health behaviors. It is based on perceived risks susceptibility belief of consequence, risk severity, benefits to action, self-efficacy and cues to action - health belief model what is the health belief model - people will not change their health behaviors unless they personally believe they are at risk and they want to avoid negative health consequences what gives you the ability to practice from your state - license what is your board exam for? (AANP or ANCC) - certification what is the process you go through in order to be allowed to bill medicare, medicaid, etc - credentials (verification process) what insurance is not affected by job changes or retirement. You are covered as long as you had an active policy when you saw the patient? - occurrence based what insurance is based on if you have coverage while you're still employed. You lose coverage as soon as you change jobs or retire (unless you purchase tail coverage when you leave) - claims based what type of insurance would ensure you continue to have coverage in the event that you leave your job? - occurrence based what are the stages of change (5) - 1. Pre-contemplation 2. Contemplation 3. Preparation 4. Action 5. Maintenance/Relapse what is the theory where the family functions as a system, a cohesive unit, one big emotional unit. Each family member plays a specific role. If one member starts to slack, another family picks it up - family systems theory what are the 3 stages in Lewin's change model - 1. unfreeze - before change occurs, figuring out how to become motivated to change 2. change - when change occurs 3. refreeze - ensure the change is permanent and becomes a new habit. Incentivizing that change what model has a goal of preventing readmissions and exacerbations. For example, may transition the patient from the hospital to a rehab, to home with home health. It revolves a lot around case management and discharge planners. - transitional care model 3 things you need when you're documenting a note about a patient with either ICD or CPT codes - 1. History 2. Physical Exam 3. Plan What must you document that identifies the diagnosis. Tells the insurance what disease process of condition that we are billing for - ICD-10 what must you document that identifies the procedure performed? Examples - diagnostics, labs, xrays, surgical procedures - CPT code what is when an error happens and we go back to see where this issue continually falls through the cracks/holes. It is for risk analysis and management to determine root cause to prevent a situation in the future and not focused on blame. - swiss cheese model when a physician first sees a patient for a medical issue and then we (NP) sees the same patient for the same diagnosis later on, we are allowed to bill 100% for this is called what - incident to billing what allows us to reimburse at 100% instead of 85% if we see a patient for a similar problem as seen by the MD - incident to billing what sets our scope of practice as NP's and legal rights - state nurse practice act who enforces our scope of practice - board of nursing in the state you work in who are we able to have collaborative aggrements with other than physicians? - DO and Dentists NOT chiro how are we improving access to care, especially for patients following up for routine things such as HF patient giving a weight log - telehealth what are some key components of a good social history - relationship status sexual status who they live with highest level of education employed? smoking/drug/alcohol status exercise? social supports? stress? Medicare part A covers what - inpatient and hospice Medicare part B covers what - outpatient needs -diagnostic tests -second opinions -medical equipment -dialysis Medicare part C covers what - advantage plans -supplemental insurances like dental and vision Medicare part D covers what - majority of drug coverage Who funds Medicare? - federal who funds medicaid - state and federal what allows us to get reimbursed up to 85% when seeing a patient? What act? - Budget reconciliation act what requires NP's to have an NPI # (unique # to charge for our care) - Balanced Budget Act what defined meaningful use for providers? Example summary of care, history, treatment, education, etc after leaving a doctors office - hitech act what is PHI - protection of health information - do not have patient identifiers when sharing info