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who does the right thing
leaders
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who does thing right
managers
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5 leadership "what counts" factors
- recognizes opportunities
- forms a vision of what can be achieved
- challenges self and others to get the desired result
- champions ideas and people to get breakthrough results
- uses a variety of resources effectively
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3 E's of leaders
- envision
- energize
- empower
- execute
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creating the future, gaining enrollment, alignment, and commitment
envision
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creates a picture of the futrue and keeps the vision alive
focuses on possibilities-NOT limitations
enrolls and focusses the organization on the key objectives and winning strategies
personally comunicates the vision and what he/she stand for both in word and action
envision
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strategy development
business knowledge/expertise
bench marking
breakthrough thinking
are ways of accomplishing what
envision
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inspiring people to deliver the future
energize
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strategy development
effective communication
work and development plans
managing conflict
symbolic interventions
embody it
are ways to accomplish what
energize
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building peoples capability to achieve business results
enable
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periodic reviews
delegate accountability
situational leadership
rewards and recognition
are ways to accomplish what?
enable
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having a guided, measurable plan and following through with it
execution
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who was the former CEO of P&G
john pepper
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approx how many physicians are active and which level of pyramid are they and physicians completing residency work where
- 873,000
- 33% primary care
- 67% non-primary
- 90% residency goers are in patient care
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who regulates the licensing of physicians
states - medical boards
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where does funding for medical schools come from
individual states
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where does funding fo residencies come from
federal government
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first new type of medical education center (1893)
Johns Hopkins University School of Medicine
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what is the Flexnor report of 1910
a study (by AMA & Andrew Carnegie)comparing medical educations at proprietary non-university setting to John Hopkins
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emphasizes mechanical manipulation of the body by therapeutic maneuvers
- osteopathy
- developed in Missouri by Andrew Still in 1890's and they have their own accrediting organization
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First PA training program
- Duke University School of Medicine in 1965.
- vietnam vets who worked as medical corpsman
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stipulation of PA practices
perform under physician supervision - delegated authority
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largest health profession in the USA
registered nurses
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Primary employmet setting fo registered nurses
- hospitals - 62%
- ambulatory/community care - 25%
- long term care - 5%
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in 2008 what degree did the majority of active nurses obtain
- associate - 45%
- baccalaureate - 34%
- diploma - 20%
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did the number of nurse practitioners increase of decrease from 1992-1997
- exploded!
- 1500 in 1992
- 8000 in 1997
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is there a national licensing exam for NPs
no, administered by different organizations and are specialty specific
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what level of education does a NP generally have
2 years masters degree who previously attended baccalaureate degree's in nursing
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education level of a Doctor of Nursing Practice
4 year graduate expeience following bachelors in nursing
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trend of social workers from 2008-2018
increase from 640,000 to 745,000
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what setting do social workers generally come into play
transition from hospital to home and hospital to extended care facility
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minimal educational requirement for social workers
bachelor's, but most require a masters in social work plus state licensure
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licensed cliinical social workers level of education
masters plus 2 years of academic practical experience in the field
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top 6 healthcare professions
- registered nurses
- physicians
- pharmacists
- dentists
- physical therapists
- nurse practitioners
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workforce demographics from 1975-2005 for registered nurses
physicians
pharmacists
- doubled
- increase by 75%
- increased by 50%
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2 parts to the equation to the supply of healthcare professionals
- 1. adequacy of workforce
- 2. judgment about how many physicians, nurses, or pharmacists are actually required
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2 schools of thought on workforce shortages
- 1. market deman
- 2. workforce requirements
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In 2010 what was the proportion of women in the fields of nursing, pharmacy and physicians
- nurse 90%
- pharmacy 50%
- physicians 30%
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number of professionally active PA's in the USA
60,000
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5 tasks of social workers
- assessing person,behavioral,family/work situations
- connecting pts to medical equipment and in-home services
- nursing home/extended care placements
- investigation neglect and abuse
- helping with insurance
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supply of active physicians, nurses and pharmacists per 100,000 population in 2010
- physician - 210,000 (150,000 specialists and 60,000 generalists)
- nurses - 800
- pharmacists - 75
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2 main pharmacy practice settings
- retail - 60%
- hospital - second largest
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percent of pts that experience a medical injury while in the hospital (harvard)
13.8%
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of injuries leading to death what percent involved negligence (harvard)
51%
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6 core quality dimensions of health care
- safe
- timely
- effective
- efficient
- equitable
- patient-centered
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triad of traditional quality assurance
- licensure
- peer review
- accreditation
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3 criteria for accreditation
- structural - working condition of defibrillator
- process - medical records dictated and signed in a timely manner
- outcomes - mortality rates, preventable wound infections, rates of sdverse drug reactions
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guidlines created in 1989 to improve quality of clinical outcomes
agency for healhcare research and quality (AHRQ)
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what 2 things should practice guidelines take into account
- scientific data
- patient preferences
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2 basic indicators of improving quality
- process measures - types of service delivered by caregivers
- outcome measures - death, symptoms, mental health, etc
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what does medicare pay for in terms of care
pays for skilled care by not custodial care
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what is the limiting factor of private long term coverage
Experience rating - median income of >65 is 31,000. 1 year in nursing home stay around 76,000
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what happened in medicaid that provided more care to try and prevent nursing home admissions
- 1915 (c) waivers
- oregon allocated 71% of long-term medicaid dollars to this program
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what is community-based & home health services
intermediate between the home and the nursing home trying to keep people independent as long as possible while still receiving necessary care
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omnibus budget reconciliation act of 1987
- set standards for nursing home quality
- mandated surveys for enforcement
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pepper commission 1990
- bipartisan commission to address LTC
- financed by increasing social security
- would help with ADL's & IADL's
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On Lok
- long term care in the chinese community caring for the frail elderly.
- received capitated payments from the Medi's
- less nursing home and more ambulatory and community based services
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describe the 3 levels of health promotion & disease prevention
- 1 - increase socioeconomic status to decrease chronic care expenditures
- 2 - population attempt (public health)
- 3 - prevention on an individual level (preventive interventions (pri. and sec.) by primary care providers)
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first epidemiological revolution
- 19th century, infectious diseases that could be prevented and improve overall quality of life.
- immunizations & improved living standards through public health measures
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second epidemiological revolution
- cancer, heart diseas & stroke
- 1980 - 2006 big push to address these because they were largely preventable
- also addressed risk factors that was implicated for 37% of the deaths
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3 risk factors that were implicated for 37% of the deaths in the second epidemiological revolution
- tobacco (435,000 deaths)
- high fat diet and inactivity (365,000 deaths)
- alcohol (85,000 deaths)
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second epidemiological revolution effects on coronary heart disease
decreased by 61% and associated with reduced rates of tobacco use and lowered mean cholesterol levels
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2 models on perspectives on chronic disease prevention and populations targeted
- medical model - high risk individuals
- public health model - disease in populations as a whole
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advantage of the public health model over the medical model
targeting a large number of people at small risk for disease can reduce a larger portion that could progress to high risk rather than targeting a small number who are already high risk
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what do the two models of chronic disease prevention have to do with physicians
changes our focus from the top heavy specialists to the smaller portion of generalists and focuses on prevention
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4 major risk factors for coronary heart disease
- eating a rich diet
- elevated levels of serum cholesterol
- cigarette smoking
- hypertension
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which medical model was most effective in the anti-smoking campaing of the last 30 years
- public health
- public education
- cigarette taxes
- restriction of smoking in public places
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is drug Tx of CHD with statins more effective in primary or secondary prevention
secondary
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screening and early detection of elevated blood pressure is what prevention of HTN
secondary
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screening and early detection of elevated blood pressure is what prevention for coronary artery disease
primary
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6 risk factors for breast cancer
- >65 yo
- family history
- atypical hyperplasia on breast biopsy
- birth in north america or northern europe
- genetic suseptibility - BRCA genotype
- women with more menstrual cycles
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which type of prevention has the highest return on investment (ROI)
primary - increased primary prevention can add up to 50% savings
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3 primary prevention that lead to 3 reduced disease states
- smoking prevention
- cholesterol reduction
- BP management
- coronary heart disease
- cancer
- stroke
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5 points on the cost savings slide
- 1. cost effectiveness data complex and mixed
- 2. primary prevention via public health measures more cost effective than primary prevention via medical care
- 3. public health measures avert millions of expensive one on one interactions with medical care providers
- 4. HIGH ROI for measles mumps and rubella immunizations
- 5. HIGH ROI for physician counseling on smoking cessation
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3 areas rated on for pay for performance in the integrated healthcare association in california
- clinical care
- patient satisfaction
- development of information technology
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