Healthcare System Study Guide

In the natural history of a disease, the pre-pathogenesis period refers to:

a) the period after disease diagnosis when a treatment plan is developed.
b) the period of post-acute treatment care planning to prevent future complications.
c) behavioral, genetic, environmental, and other factors that may contribute to an individual’s likelihood of contracting a disease.
d) prenatal assessment of potential fetal disorders.
c

Tertiary prevention describes:

a) use of experimental treatments when traditional treatments have failed.
b) health coaching by non-medical professionals.
c) rehabilitation and maximizing remaining functional capacity when a disease or condition has occurred with residual damage to physical functionality.
d) periodic disease screening for high-risk populations.
c

The ACA will provide new access to health care for millions of Americans. However, health services researchers caution about overstating the link between insurance and health. The basis for their caution is:

a) improvements in population health will require merging public health concepts into personal medical care approaches.
b) low-income persons’ tendency to undervalue healthcare services.
c) most low-income persons will not subscribe to the ACA’s insurance plans or Medicaid.
d) the ACA’s emphasis on insured prevention and wellness services is unappealing to most Americans.
a

The natural history of disease is best described as:

a) a matrix used by epidemiologists and health services planners that places everything known about a particular disease or condition in the sequence of its origin and progression when untreated.
b) predictable outcomes of a particular condition related to the aging process.
c) documentation of a disease’s earliest historical recognition.
d) disease progression in the pre-antibiotic era.
a

In its early origins in colonial America, the patient/physician relationship can be best characterized as:

a) complicated in terms of the ways that patients paid for treatment.
b) strict contracted arrangements between physicians and patients.
c) interactive and supportive of patient involvement in treatment decisions.
d) personal, confidential, and simple, with payments based on patients’ ability to pay.
d

Problems of the healthcare delivery system are historically rooted in balancing cost, quality, and access. These problems generated competition between the government and private sectors in the 1990s, best characterized by which of the following?

a) Market-oriented changes, competition, and privately organized managed care programs
b) Government efforts to control all aspects of health services delivery
c) Federal initiatives to limit private insurers’ entry into the health insurance marketplace
d) Private business initiatives to control government programs for the undeserved
a

In the past, patient behaviors were formed from the authoritarian positions of better-educated providers who expected patients to be compliant and grateful. Today, healthcare providers and consumers:

a) appreciate the reasons why health professionals deserve superiority.
b) are bonded with each other in a joint provider-consumer mindset.
c) increasingly engage in “shared decision-making.”
d) rely on the legal system to determine boundaries of patient/provider decision-making.
c

Of the levels of prevention associated with the natural history of disease, primary prevention refers to:

a) rehabilitation.
b) disability limitation.
c) early diagnosis and prompt treatment.
d) health education and specific protections such as immunizations.
d

One reason why employers are a major stakeholder group in the healthcare industry is:

a) Americans’ reliance on company-based wellness programs.
b) their payment of a high proportion of healthcare costs.
c) None of these is correct.
d) the political influence of individual, large company owners.
b

Secondary prevention describes:

a) early detection and prompt treatment of a disease or condition to achieve an early cure, if possible, or to slow progression, prevent complications, and limit disability.
b) public education to help reduce disease risk factors.
c) efforts to return a patient to the level of functioning prior to a disease episode.
d) public health measures to limit the spread of an infectious disease.
a

provider
can be an individual health care professional, a group, or an institution that delivers healthcare services and receives reimbursement directly from those services
What is the official name of the ACA?
Patient Protection and Affordable Care Art of 2010
What are the five questions health-services researches ask when assessing the value of technologic advances?
1) How does new technology benefit the patient?
2) Is it worth the cost?
3) Are the new methods better?
4) Is treatment planning enhanced?
5) Is the outcome from disease better?
Why do health services researcher caution about overstate the link between insurance and health?
improvements in population health will require merging public health concepts into personal medical care approaches
In the natural history of disease the pre-pathogenesis period refers to?
behavioral, genetic, environmental and other factors that may contribute to an individual’s likelihood of contracting a disease
What does the acronym CHIP stand for?
Children’s Health Insurance Program
What does the acronym HMO stand for?
health maintenance organization
the most significant social legislation passed by any congress in the history of the unites states was the:
the social security act of 1935
the primary purpose of medicaid as enacted in 1965 was to:
provide health insurance for low-income individuals
the primary purpose of medicare as enacted in 1965 was to:
provide health insurance for older Americans
In colonial America, the primary function of hospitals were to:
shelter older adults, the dying, orphans, and vagrants and protect community residents from contagiously sick and mentally ill persons
the ultimate responsibility for a hospital’s quality of care, including medical care provided, belongs to the hospital’s:
Board of Directors
a major obligation of physician when obtaining informed consent for a medical procedure is to:
ensure that the patient understands the risks, benefits, and alternatives of the procedures
in health care, what term refers to a system that includes several service components with addressing one or more dimensions of a population’s healthcare needs?
vertically integrated
until the mis-1980s, hospitals were reimbursed for whatever they charged on a “retrospective” basis. now they are paid a certain amount for each patient’s care. the amount they are paid is based on:
diagnosis related groups (DRGs)
ambulatory care is best defined as
care that does not require an overnight stay in a hospital
in today’s hospitals, outpatient clinics frequently provide:
1) care for those without private physicians
2) teaching site for medical residents
3) primary care services
urgent care is best described as
care provided on a walk-in basis for acute illness and injury that is either beyond the scope of or availability of a primary care practice or retail clinic
what does the acronym AMA stand for?
American Medical Association
In health care, what is the acronym ED short for?
emergency department
in colonial America, the primary mode of medical education was:
student apprenticeship with European-trained physicians and on-the-job experience in one of the few existing hospitals
medical societies were first established for the primary purpose of:
improving the quality of medical education and practice
academic health centers may be best described as
complexes of medical schools and other health professional schools, such as nursing and allied health affiliated with each other and with teaching hospitals and other research and clinical facilities
What organization is responsible for approving the content of post-medical school residency training?
accreditation council for graduate medical education
physician employment by hospitals continues on a pathway of steady growth. one reason why physicians are leaving private practice for hospital employment is:
increasingly complex health insurance and information technology demands on private practice
a physician residency training program is best described as
an accredited training program of at least 3 years post-medical school that prepares physicians to practice in a medical specialty
complementary medicine differs from alternative medicine in that complementary medicine
is used together with conventional medical treatment, while alternative medicine is used in place of conventional medical treatment
the widespread use and popularity of complementary medicine in the U.S. resulted in which of the following developments?
the national institutes of health creating the national center for complementary and alternative medicine (NCCAM), later renamed as the national center for complementary and integrative health (NCCIH)
today, it is generally accepted that nurse practitioners should be registered nurses with:
a mater’s degree
Three organization elements essential for successful health information systems implementation are:

a) time, effort, and money.
b) technology, policies and procedures, and culture.
c) competency, character, and courage.
d) training, testing, and evaluation.
b

Most electronic health records (EHRs) are not designed to share patient health information between systems and institutions. A solution for overcoming this limitation in current EHR design has been the development of:

a) cultural sensitivity training among organizations.
b) health information exchanges (HIEs).
c) the Systematic Nomenclature of Medicine (SNOMED).
d) monolithic architecture.
b

“Meaningful use” of electronic health records is best described as:

a) criteria defined by the Office of the National Coordinator in collaboration with the Centers for Medicare and Medicaid services that require meeting time-limited objectives in order to quality for incentive payments under the HITECH Act.
b) physicians and other providers making electronic health records accessible to patients.
c) physicians and hospital managers passing federal examinations on electronic health record creation and applications.
d) efficient applications of electronic health records under internal criteria established within physician practices and hospitals.
a

A computerized decision support system (CDSS) is best described as an electronic system that:

a) requires physicians to adhere to recommended schedules of preventive services based on patient diagnosis.
b) allows physicians to list orders for patient treatment including prescriptions in an electronic health record.
c) substitutes computerized information for physician judgments.
d) matches individual patient data with a computerized knowledge base such as evidence-based clinical guidelines to remind physicians to do things for patients they might have forgotten about.
d

The single most important factor in accelerating health information technology adoption since 2008 has been:

a) widespread recognition of technology’s contribution to the quality of patient care.
b) financial incentive programs that reward “meaningful use” or the use of e-prescriptions.
c) results achieved by electronic health records in reducing expenditures.
d) patients’ demands for electronic access to their personal health records.
b

In today’s hospitals, outpatient clinics frequently provide:

a) teaching sites for medical residents.
b) care for those without private physicians.
c) All of these are correct.
d) primary-care services organized similarly to private physician offices.
c

Which of the following is not a principle of a patient-centered medical home?

a) The personal physician leads a team of individuals in the practice who take responsibility for the ongoing care of patients
b) Care is coordinated and integrated across all elements of the delivery system (subspecialty, hospital, home, nursing home), facilitated by electronic record registries
c) Use of electronic health information technology for patient communication is discouraged
d) Providing for all of a patient’s healthcare needs or appropriately arranging care with other qualified professionals
d

A major obligation of physicians when obtaining informed consent for a medical procedure is to:

a) ensure that the patient understands the risks, benefits, and alternatives of the procedure.
b) shield the patient from information about possible negative side effects.
c) protect themselves from malpractice claims.
d) ensure that family members agree with the patient’s decision.
a

In the 1990s, ambulatory care facilities of all types proliferated. Reasons for this proliferation include which of the following?

a) Physician freedom from hospital facility scheduling
b) All of these are correct.
c) Consumer preferences
d) Physician profit-making opportunities
b

In health care, which of the following terms refers to a system that includes several service components with each addressing one or more dimensions of a population’s healthcare needs?

a) Parallel structured
b) Horizontally integrated
c) Vertically integrated
d) Laterally integrated
3

“Urgent Care” is best described as care:

a) for fast treatment of easy-to-diagnose conditions.
b) provided on a walk-in, extended-hour basis for acute illness and injury that is either beyond the scope of or availability of a primary care practice or retail clinic.
c) absorbing overflows of patients from crowded hospital emergency departments.
d) that does not require the services of a physician.
b

The ultimate responsibility for a hospital’s quality of care, including the medical care provided, rests with a hospital’s:

a) board of directors.
b) chief executive officer.
c) medical staff organization.
d) department of quality management.
a

The development that contributed most significantly to the decline of the social mission of voluntary hospitals was the:

a) development of high-technology hospital care.
b) passage of 1973 HMO legislation.
c) specialization of clinical practice.
d) enactment of private and public insurance reimbursement for hospital care.
d

Ambulatory care is best defined as:

a) health services requiring ambulance transport.
b) health services in primary care doctors’ offices.
c) healthcare services that require patients be able to “walk in” to the site of service.
d) care that does not require an overnight stay in a hospital.
d

In colonial America, the primary functions of hospitals were to:

a) provide congregate sites for training of nurses.
b) shelter older adults, the dying, orphans, and vagrants and protect community residents from contagiously sick and mentally ill persons.
c) support scientific research.
d) provide entrepreneurial enterprises for business-minded physicians.
b

For many years, the standard for assessing hospital quality of care was peer review using physician audits of selected patient records to judge “the degree of conformity with preset standards.” Which of the following was not a reason for the ineffectiveness of such audits?

a) No rational basis existed for chart selection to permit extrapolation of sample findings to the larger patient population
b) When deficiencies were identified, reviewers were reluctant to pass judgment on their colleagues
c) Reviewers used implicit standards to make qualitative judgments
d) Hospital administrators influenced how reviewers were selected
d

Through discharge planning, hospitals help assure that safe and appropriate post-hospital care is arranged for each patient. Medicare patients may appeal what they believe to be a premature or inappropriate discharge by petitioning which of the following organizations?

a) Hospital medical staff organization
b) Quality improvement organization (QIO)
c) American Hospital Association
d) Hospital board of directors
b

Beginning in the 1980s, a significant advance in the provision of hospital emergency department services occurred with the introduction of:

a) electronic health records.
b) board-certified emergency medicine physicians.
c) physician assistants.
d) MRI diagnostic equipment.
b

“Hospitals can no longer live in a four-walls, brick-and-mortar world.” This statement refers to which encompassing principle of healthcare reform?

a) Measures of hospital quality will become more transparent and available to the public
b) Primary doctors will be the system leaders, not specialists
c) Focus on population health status with community-based care delivered in multiple provider sites
d) Almost every American will have health insurance coverage
c

In its landmark report on hospital errors, “To Err is Human,” the Institute of Medicine emphasized that errors in care most typically originate from which one of the following sources?

a) Deficiencies in the systems of care
b) Distracted, fatigued physicians
c) Medical equipment failures
d) Inadequate nurse training
a

The predominant services of local public health departments today are:

a) child and adult immunizations.
b) school-based pediatric medical care.
c) specialty services for high-risk pregnant women.
d) chronic disease screening.
a

Until the mid-1980s, hospitals were reimbursed for whatever they charged on a “retrospective” basis. Now they are paid a certain amount for each patient’s care on a predetermined “prospective” basis. The amount they are paid is based on:

a) empirical data.
b) diagnosis related groups (DRGs).
c) prospective patient categories (PPCs).
d) costs of resources used.
b

Clinical observation units (COUs) may be best described as hospital units associated with emergency departments which:

a) observe and monitor the most seriously ill patients.
b) use a period of 6-24 hours to triage, diagnose, treat, and monitor patients with common complaints.
c) assess patients with possible heart attacks or strokes.
d) assess frequent emergency department users.
b

Technological and clinical advances that allow many surgical procedures to be safely performed on an ambulatory basis had what corollary effect on hospitals?

a) Hospital outpatient service volume and revenues increased.
b) Hospitals sold their ambulatory services to physician groups.
c) New joint-business relationships with physicians rapidly developed.
d) Physicians became competitors with hospitals for the same lines of business.
d

The primary organizational mode of medical care in the United States, in terms of volume of services delivered, is:

a) hospital ambulatory clinics.
b) community-based clinics run by voluntary agencies.
c) private practice physicians’ offices.
d) government-operated health clinics.
c

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