ANSWERS SURE A+
✔✔Five Domains of Value Based Purchasing - ✔✔1) Clinical Care Outcomes (Heavy
emphasis on mortality)
2) Patient Experience (HCAPHC Patient Survey)
3) Efficiency (Medicare spending per beneficiary, resource utilization, LOS, post acute
services.
4) Safety (Patient Safety Indicators, Infection Rates)
5) Clinical Care Process (Core Measures)
✔✔Readmission Risk Assessment - ✔✔Readmissions within 30 days. Critical to assess
risk of readmission and implement strategies to to prevent unnecessary admissions.
May actually be performed closer to discharge to better assess the patient's current
condition. Risk score also includes LOS.
There are several tools including Project Boost Risk Assessment, LACE, and Project
Red Toolkit. Assess severity of illness, factors that pt pt at higher risk or readmission,
and allow interventions to be put in to help.
, ✔✔Pre-admission Assessment - ✔✔Critical step in guarding resources of patient and
organization. Also identify patient and family goals. Can determine appropriateness of
procedure, Level of care, and post acute needs.
Allows for auth to be obtained prior to procedure and to address needs to avoid delays
in discharge. Expectations of LOS
✔✔Admission Assessment - ✔✔Nursing completes an admission assessment when
admitted to the hospital. Case Manager can use some of the info to gather preliminary
info for case management assessment.
If readmission assessment was done, important to verify all info is the same.
✔✔Ongoing asssessment - ✔✔Reassessment is required by CMS CoP and Joint
Commission as changes can occur during hospitalization.
✔✔Health Literacy - ✔✔Educational Level does not correlate with health literacy.
Health Literacy is degree to which individuals have the capacity to understand basic
healthcare info and services needed to make appropriate healthcare decisions.
A quick way to assess health literacy is to have patient repeat info back to you in own
words. Can also give patient something to read and repeat back.
✔✔Preferred Healthcare Language - ✔✔Utilize resources to provide translation. Family
members cannot be used as interpreters.
Title IV Civil Rights Act specifies that any entity getting federal money cannot
discriminate, including limited English proficiency.
Hearing Impaired are also protected by Americans with Disabilities Act requiring
hospitals to provide interpreters.
✔✔Case Management Initial Assessment - ✔✔- Establish Rapport
- Verify information from other sources.
-Always verify demographic data
- Patient Expectations for procedures/hospitalization
-Communicate info to care team.
✔✔Categories for Assessment - ✔✔-Health Behaviors (How patients perceive
themselves).
- Social Determinants (economics, neighborhood, education)
- Response to Illness (Coping skills, adjustment, support)
- Belief and Value System (culture/religious)
-Medical History (H&P)