historically, what type of care or services did hospitals focus on? course hero

What was the theme of hospitals in the 1990s?

Health maintenance organizations, which contracted with a network of providers for discounted prices, increased in importance. The focus of care shifted to outpatient services, ambulatory care centers for acute care, and hospices and nursing homes for the chronically ill. [22] Then in 1997, the Balanced Budget Act decreased Medicare payments to hospitals by $115 billion over five …

What are the characteristics of a hospital?

Historically, health insurance was for hospital care and related services only. What effect did this characteristic have on the health behaviors of individuals enrolled in such plans? A) Some individuals neglected health promotion measures. B) Many individuals began to pay out-of-pocket for superior care. C) Individuals avoided hospitals ...

What did the government do to help hospitals after WW2?

In the 1950s and 1960s, service health insurance plans became more common. These plans generally did not require policyholders to pay a fixed amount for health care services, but rather they paid a fixed monthly premium and received coverage for a set number of services (e.g., hospital stays, doctor visits, prescription drugs) each year.

What is the history of hospitals in America?

When was the Joint Commission on Accreditation of Hospitals established?

In 1951 , the Joint Commission on Accreditation of Hospitals (JCAH) was established [15]as a non-profit organization with the intended function of providing voluntary accreditation of hospitals based on a rubric of defined minimum quality standards.

What is the purpose of the Affordable Care Act?

The law contains multiple provisions designed to modify the manner in which care is delivered to Medicare and Medicaid patients, and the system by which provider payment is determined, with a central objective of improving quality while lowering healthcare costs and expanding access .

What was the purpose of Medicare and Medicaid?

Medicaid was established in response to the perceived inadequacy of the "welfare medical care" under public assistance at the time. Title XVIII of the Social Security Act, commonly known as Medicare and entitled “Health Insurance for the Aged and Disabled,” established a health insurance program for aged persons. Under this provision, Americans 65 years and older were qualified to receive compulsory hospital insurance (part A) and voluntary supplementary medical insurance (part B) [ 11 ]. In anticipation of the need to assess and direct the care of Medicare patients, Congress established a set of conditions entitled “Conditions of Participation,” which required the implementation of several elements deemed necessary for hospital operation. These conditions included staff credentials, 24-hour nursing services, and utilization review [ 12 ]. In accordance with these requirements, Utilization Review Committees were established in 1972, to identify if hospitals and medical personnel were providing appropriate clinical services that met conditions of participation. While this system of review committees held potential for effective monitoring, its success was limited. The lack of effectiveness was retrospectively attributed to an absent association between the review process and the identification of ways to improve care. In addition there was an absence of formal evaluation criteria to guide providers’ decision making, and to adjust payment based on the quality of care [ 13 •].

Who is the origin of quality improvement?

The roots of the quality improvement movement can be traced back to the work of epic figures such as Ignaz Semmelweis, the 19th-century obstetrician who championed the importance of hand washing in medical care. In addition, Florence Nightingale, the English nurse, identified the association between poor living conditions and high death rates among soldiers treated at army hospitals. Ernest Codman, a surgeon, pioneered the creation of hospital standards and emphasized and implemented strategies to assess healthcare outcomes. The modern quality movement has since transformed to include a wide variety of stakeholders, a range of unique and modified approaches, and an evolving set of goals [ 1 ].

What is the Donabedian model?

Avedis Donabedian, physician and founder of the study of quality in health care and medical outcomes research published “Evaluating the Quality of Medical Care” [ 16 ], a replicable and highly useful model that relies upon the elements of structure, process, and outcomes to examine the quality of care delivered. When applied to orthopedics, the Donabedian Model suggests that care structures (ie, assigning a dedicated arthroplasty care team) and care processes (ie, designing and implementing a standard arthroplasty care pathway) can contribute to patient outcomes. This will also include clinical endpoints such as functional status, pain, complications, morbidity and mortality, as well as patient based experiences, and utilization of resources. This model provides a basis for the current methods used to evaluate healthcare quality [ 17 •].

What is NCQA accreditation?

NCQA is a non-profit organization tasked with managing accreditation programs for individual physicians, health plans, and medical groups.

What is PQRI in healthcare?

With a growing focus placed on the physician as the target of feedback and incentives, public reporting efforts in 2006 led to the development of the Physician Quality Reporting Initiative (PQRI), entitled the Physician Quality Reporting System (PQRS) as of 2011 [ 37 ]. Under the Tax Relief and Health Care Act of 2006 (TRHCA), PQRI began as a voluntary pay-for-reporting program. The program was set to provide incentive payments in the form of a 1.5 % bonus on total allowed Medicare Part B Fee-For-Service (FFS) charges for successful reporting on a minimum of 3 quality measures, or for 1 of 14 measure groups for the reporting period of July 1, 2007 through December 31, 2007 [ 37 ]. Under the Medicare Improvement for Patients and Providers Act of 2008 (MIPPA) [ 38 ], PQRI incentive payments were increased to 2 % for successful participation in both the 2009 and 2010 program years, and public reporting became mandatory. A unique element of the PQRS was its focus on pay-for-reporting at the individual physician level [ 17 •]. However, while participation in PQRS is currently voluntary, beginning in 2015, all providers eligible for incentive payments will be subject to penalties for failing to participate. The penalty is set to begin at a 1.5 % reduction for those who fail to report on the minimum measure set and scheduled to increase to a penalty of 2 % reduction in reimbursement in 2016 and beyond [ 39 ]. The goal of the PQRS program is to incentivize the discussion of quality oriented questions between patients and providers, and to promote awareness among providers of the opportunities for quality improvement present in daily care and process [ 40 ].

What is a nurse in healthcare?

While many may think of a nurse as someone who takes care of hospitalized patients, nurses also fill a wide variety of positions in health care in many varied settings, working both collaboratively and independently with other health care professionals. For example, most Americans are familiar with home care nurses who provide a plethora ...

When did the Philadelphia Hospital School of Nursing graduate?

Philadelphia Hospital School of Nursing, first graduating class, 1886. Chief Nurse Alice Fisher is fourth from the right, second row from the bottom. The year 1873 was a watershed year in American professional nursing history.

What was the purpose of the Almshouse?

The Philadelphia Almshouse, 1835 Throughout history most sick care took place in the home and was the responsibility of family, friends, and neighbors with knowledge of healing practices. In the United States, family-centered sickness care remained traditional until the nineteenth century. Sick care delivered by other than family and close acquaintances was generally limited to epidemics and plagues that periodically swept through towns and cities. By the beginning of the nineteenth century, however, urbanization and industrialization changed the way in which—and in many cases the place in which—sick individuals received care. Hospitals began to proliferate to serve those who were without the resources to provide their own care, and as hospitals increased in numbers so did the demand for caregivers who would be able to deliver thoughtful care to the patients in them. Early nineteenth-century hospitals were built mainly in more populated sections of the country, generally in large cities. Nursing care in these institutions differed enormously. In hospitals operated by religious nursing orders, patients received high quality care. But, in other institutions, nursing care was more variable, ranging from good in some hospitals, to haphazard and poor in others.

Who was the first woman to become a nurse?

Florence NightingaleMost people think of the nursing profession as beginning with the work of Florence Nightingale, an upper class British woman who captured the public imagination when she led a group of female nurses to the Crimea in October of 1854 to deliver nursing service to British soldiers.

Why are nurses important?

Nurses are critical links in maintaining a cutting-edge health care system.Nursing continues to be an indispensable service to the American public. 21st century nurses preparing to care for a patient in a modern acute care hospital. While many may think of a nurse as someone who takes care of hospitalized patients, ...

How many nursing schools were there in 1900?

By 1900, somewhere between 400 to 800 schools of nursing were in operation in the country. These programs followed a fairly typical pattern.

Where do nurses work?

While most nurses work in acute-care settings such as hospitals, nurses’ expertise and skills extend well beyond hospital walls. Working independently and with other health care professionals, nurses promote the health of individuals, families, and communities. Millions of Americans turn to nurses for delivery of primary health care services, ...

Florence Nightingale

Nursing and Hospital Care in The United States

The Beginnings of Nurse Education

Professional Nurse Education Begins

The Profession of Nursing Organizes

Challenges For Nursing

Nursing Diversifies

• Despite the many difficulties within the profession, nursing continued to grow as an occupational field and became recognized as an essential health care service by the early twentieth century. Nurses fanned out into diverse fields delivering services to many people outside of hospitals. For example, Lillian Wald founded the Henry Street Settlement...

See more on nursing.upenn.edu

Mid-Twentieth Century Nursing

The Modern Practice of Nursing