1
Q
- British royal navy (1799 in US Navy)
- Congress required all ships have area for sick/injured
Duties: - Assist surgeon
- Sweeping/washing/cleaning guns/make pills and plaster, delivering food, etc
A
Loblolly boys
2
Q
Who was the first loblolly boy on record?
A
john wall
3
Q
- 17th-18th century
- german military assistants to barber-surgeons; expanded to Russia by Peter the Great
- provided primary care to rural and underserved areas; authority to diagnose, prescribe, and give emergency treatment
- 2 years of medical training
A
Feldshers
4
Q
- 1965 - China
- farmers trained as village aides
- less than 6 months training
- provides basic hygiene, preventative health care, family planning, treat common illnesses
A
barefoot doctors
5
Q
- 1925 - mary breckinridge
- maternal and child health care in rural kentucky
- used nurse midwives from Great Britain
- 1939 - frontier graduate school of midwifery - 1st midwifery program
A
frontier nursing services
6
Q
- surgical laboratory assistant
- trained by Dr. Alfred Blalock
- awarded an honorary doctorate degree despite never being formally trained in medicine
A
Vivian Thomas
7
Q
- President of National board of medical examiners
- 1st physician to suggest non-physician providers; 2-3 years of college that paralleled medical school
- practiced in Cleveland, OH
A
Dr. Charles Hudson
8
Q
- Founder of the PA profession (Duke University)
- 1964 - announced he would create a “course of study for corpsmen to become PAs”
- developed curriculum for “advanced clinical nursing” with Thelma Ingles
A
Dr. Eugene Stead
9
Q
When is Dr. Eugene Steads birthday?
A
october 6
10
Q
- general practitioner in NC
- trained “doctor’s assistants”
- trained Henry “buddy” Treadwell to diagnose and treat
A
Dr. Amos Johnson
11
Q
Who was the prototype for the PA program at Duke?
A
Henry Treadwell
12
Q
- Confirmed the need to train nonphysician providers
- Founded MEDEX
A
Dr. Richard Smith
13
Q
- Professor of Pediatrics
- Developed Child Health Associate Program (University of Colorado)
A
Dr. Henry Silver
14
Q
- Founded Alderson-Broaddus College PA Program
- Native PCP in rural WV
- Develop training program designed to recruit high school students native to the area
A
Dr. Hu Myers
15
Q
Duke University information
A
- first class: october 6, 1965
- four students, ex-navy corpsmen
- 9 months didactic, 15 months rotation
- North Carolina
- Based on medical model, primary care focus
16
Q
MedEx information
A
- Richard Smith
- University of Washington
- 1969
- rural primary care physicians
- train individuals with medical background for primary care settings in rural and underserves areas
17
Q
Alderson-Broaddus College information
A
- 1968
- Dr. Hu Myers
- 4 years bachelor’s degree
- enter directly from high school
- became model for smaller colleges
- closed fall 2023
18
Q
What is this the mission of?
Share history of the development of the PA profession and illustrate how Pas continue to make a difference in our society
A
PA history society
19
Q
What is this the vision of?
Brings PA history alive by inspiring next generation of Pas, patients, and policy makers
A
PA history society
20
Q
What is this describing:
Vision:
- PAs transforming health through patient-centered, team-based medical practice
Mission:
- Leads the profession and empowers our members to advance their careers and enhance patient health (through philanthropy and service)
A
AAPA
21
Q
What does AAPA do?
A
Advocacy, education, practice resources, research, publications, professional recognition, professional practice council, international affairs, The Physician Assistant Foundation, Physician Assistant History Society
22
Q
When did AAPA start?
A
1968
23
Q
What is this describing:
Purpose:
- Provide certification programs that reflect standards for clinical knowledge, clinical reasoning, and other medical skills and professional behaviors required upon entry into practice and throughout the careers of Pas
Passion:
- Dedicated to serving the interest of the public. We do so with a passionate belief that certified Pas are essential members of the health care delivery team who provide millions access to more affordable, high quality health care
A
NCCPA
24
Q
What did NCCPA start?
A
1975
25
What came out of NCCPA?
- PANCE
- PANRE
- Certificates of added qualifications
26
What is this describing:
- Defines education standards and evaluates PA programs ongoing basis
Mission:
- Protects the interests of the public and the PA profession, including current and prospective PA learners, by defining the accreditation standards and evaluating PA educational programs to ensure their compliance with those standards
ARC-PA
27
When was ARC-PA established?
1988
28
What are the roles of ARC-PA?
- Establish educational standards utilizing broad-based input
- Define and administer the process for comprehensive review of applicant programs
- Define and administer the process for accreditation decision-making
- Determines in PA educational programs are compliant with the established standards
- Work collaboratively with its collaborating organizations
- Define and administer a process for appeal of accreditation decisions
29
What is this describing:
Vision:
- Health for all
Mission:
- “advancing excellence in PA education through leadership, scholarship, equity, and inclusions”
PAEA
30
What does PAEA do?
- Education (conferences/CME, faculty/leadership development)
- Research (survey reports)
- Advocacy (government relations)
- Publications (JPAE)
- Assessments (PACKRAT, End of rotation exams, end of curriculum exam)
31
When was PAEA established?
1972
32
What promotes quality, cost-effective, accessible health care through the physician assistant-physician team approach?
OAPA
33
When was OAPA established?
1978
34
What does OAPA do?
- Education (conferences/CME)
- Advocacy
- Networking (regional directors)
- Healthcare industry liaison
- Represents Ohio Pas in other State/National organizations
- Works with Ohio PA program directors
- Outreach/support of Ohio PA students
- Achievement recognition
- PA career forum
- Outreach to local community
35
What are the 3 most important roles of OAPA?
- professional advocacy
- education
- promote PA practice
36
The conduct, aims, or qualities that characterize or mark a profession or a professional person
professionalism
37
What professional competencies are PAs expected to demonstrate?
- Adherence to policy
- Respect
- Flexibility
- Honesty and integrity
- Trustworthiness
- Concern for the patient
- Patient confidentiality
- Maintaining composure
- Timeliness and attendance
- Communication
- Professional appearance
38
How can one express professionalism?
- Expression of positive values and ideas
- Prioritizes interests of others above own interests
- Acknowledges own professional and personal limitations
- Practice without impairment from substance abuse, cognitive deficiencies, or mental illness
- Maintain high level of responsibility, ethical practice, sensitivity to diverse population and adherence to legal and regulatory requirements
39
The ability to respect other people’s diversified cultural backgrounds and unique set of experiences in the workplace
professional maturity
40
What are some attributes of professional maturity?
- Professional attitude
- Work excellence
- Professional dress
- Time management
- Leadership
- Professional communication
41
How can attributes of professional maturity apply to individual professional growth?
- earn respect of co-workers
- strengthen team work
- build better relationships with patients
42
monitoring one’s own emotions and guide one’s thoughts and actions in a healthy manner; ability to control impulse
emotional intelligence
43
What are examples of emotional intelligence?
- self-awareness
- self-regulation
- motivation
- empathy
- social skills
44
a method of problem-solving that is unbiased and with an honest attitude
intellectual honestly
45
What are some examples of intellectual honestly?
- One’s personal beliefs don’t interfere with the pursuit of truth
- Relevant facts and information are not purposefully omitted when they contradict one’s hypothesis
- Facts are presented in an unbiased manner, not twisted to give misleading impressions or to support one view over another
- References are acknowledged where possible and plagiarism is avoided
46
What are Goleman's 5 domains of emotional intelligence?
- knowing one's emotions
- managing one's emotions
- motivating oneself
- recognizing emotions in others
- handling relationships (boundaries)
47
What are the 6 elements of professionalism?
- altruism
- accountability
- excellence
- duty
- honor and integrity
- respect for others
48
- The belief in or practice of disinterested and selfness concern for the well-being of others; the essence of professionalism
- best interest of the patients, not self interest
altruism
49
The fact or condition of being accountable; responsibility
accountability
50
What are the different levels of accountability?
- patients (provider/patient relationship; providing unbiased information)
- society (addressing health needs to the public)
- profession (adhering to ethics of medical practice)
51
- The quality of being outstanding or extremely good
- Effort to exceed ordinary expectations
- Committed to life-long learning
excellence
52
- A moral or legal obligation; a responsibility
- Commitment to service
duty
53
What are examples of duty for the patients? for the profession?
patients:
- being available and responsive
- accepting of inconvenience to meet the needs of the patients
- advocating care for patient regardless of ability to pay for services
- accepting risks of oneself when pts welfare is at stake
profession:
- active roles in professional organizations
- volunteering
- paying it forward
54
firm adherence to code of especially moral or artistic values
honor
55
adherence to what is right; adherence to a code of conduct
honor
56
What are some examples of honor and integrity?
- keeping your word
- keeping commitments
- being straightforward
57
- Essence of humanism
- A feeling of deep admiration for someone or something elicited by their abilities, qualities, or achievements
respect for others
58
What are some challenges to professionalism?
- abuse of power (bias, sexual harassment)
- arrogance (superiority)
- greed
- misrepresentation (lying, fraud)
- impairment
- lack of conscientiousness
- conflict of interest (sexual relations)
- burnout
59
What is a set of moral standards?
ethics
60
- Patient making their own decisions
- Must be voluntary and informed
- Must be competent
autonomy
61
- Challenges autonomy
- Practice of overriding or ignoring preferences of patients in order to benefit them or enhance their welfare
- Beneficence “trumps” autonomy: best interest of the patient
paternalism
62
Promotion of the well-being of others
beneficence
63
Not deliberately causing harm to others
"do no harm"
nonmaleficence
64
Taking sufficient and appropriate care to avoid causing harm to a patient given what the circumstances would demand of a reasonable and prudent health professional
due care
65
1. Absence of due care
2. Intentionally causing harm
3. Unintentionally, but carelessly imposing risk of harm
negligence
66
1. Distinction between intended effects and merely foreseen effects
2. Single act: 1 good effect and 1 bad effect
(Intent is good but effect is bad)
rule of double effect (RDE)
67
- Fair and equitable distribution of benefits and burdens
- Treat others equally
justice
68
What are the principles of biomedical ethics?
- autonomy
- beneficence
- nonmaleficence
- justice
69
providing adequate information that is comprehendible to a competent patient or patient surrogate
informed consent
70
What is the ultimate goal of informed consent?
patient understanding
71
What are the components of informed consent?
- Diagnosis/recommendation for treatment (laterality)
- Nature of recommended procedure/treatment
- Risks and benefits (and likelihood of stated risks)
- Identity, credentials, and experience of those performing procedure
- Cost of procedure
- Must be signed, dated, time-stamped
72
the ability to understand the nature and consequences of the procedure or treatment that the patient is being asked to undergo
competency
73
Competent patient but compromised by injury or illness, anxiety, pain, or hospitalization
capacity/incapacity
74
What are the different virtues?
- integrity
- respect
- courage
- humility
- empathy
- benevolence
- justice
- prudence
75
- Allows person to be true to self when values are challenged
- Being true to one’s self and the profession
- Honesty/being truthful
- Medicine
integrity
76
The tendency to regard another as having some worth and consequently, the desire to treat them with civility
respect
77
What are the 2 levels of respect?
1. respect because they are fellow human beings (inherent and fundamental)
2. respect due to status or position in a hierarchy (over and beyond general respect we owe others)
78
Bravery in the face of trouble; can make a difficult choice despite negative consequences
courage
79
How can you apply courage in practice?
- standing up for yourself/patient
- PA-physician relationship
- whistleblower
80
- recognizing one's limitations
- recognize we are not all knowing, we are not all powerful, we will make mistakes
humility
81
How can you apply humility in practice?
- always be willing to learn more
- know limitations; ask for help
82
- understanding another person's point of view
- driven by compassion
empathy
83
How can you apply empathy in practice
- listen and communicate effectively
- develop trusting relationships
84
- The quality of being well-meaning; kindness.
- Acting in the best interest of the patient
benevolence
85
the quality of being just, impartial, fair
justice
86
How can you apply justice in practice?
- treat patients fairly
- practice non-discriminately
87
- Ability to use reason to govern and discipline oneself
- A set of principles that encourage people to consider their care needs and use the most appropriate service for their clinical needs
prudence
88
What are the four components to ethical decision making? Describe each
- agent (one making the decision)
- choices (morals help direct decision)
- consequences (result/outcome-good or bad)
- context (setting that influences the decisions made)
89
What are the ARC-PA standards - 5th edition? Describe them
- A: administration (institutional responsibilities, program personnel, admissions)
- B: curriculum and instruction (outlines didactic and clinical curriculum, SPCEs)
- C: evaluation (program self-assessment, self-study report, clinical site evaluation)
- D: provisional accreditation
- E: accreditation maintenance
90
What are the competences for the PA profession?
- medical knowledge
- clinical technical skills
- professional behaviors
- interpersonal skills
- clinical reasoning
- problem-solving abilities
91
How is the PANCE set up?
- need to graduate from ARC-PA accredited PA program
- 300 MC questions, 5 hours
- can take exam once every 90 days
92
What makes up 95% of the PANCE?
organ systems diseases/disorder questions
93
What makes up 5% of the PANCE?
professional practice questions
94
Explain certificate of added qualifications/four core components
- voluntary
- must have current NCCPA certification
- four core components:
**category I in specialty CME
**1-2 years of experience in that field of practice
**procedure/patient care case log specific to specialty
**specialty exam
95
What are the different areas you can get CAQs in?
- cardiovascular/thoracic surgery
- derm
- emergency medicine
- hospital medicine
- nephrology
- OB/GYN
- ortho surgery
- peds
- palliative and hospice care
- psych
96
Explain CMEs
- 2 year cycle
- 100 CME + 12 in pharm (ohio)
- 50 cat. I (clinical preceptors, performance improvement, self-assessment)
- no minimum cat. II (reading, etc)
97
- Granted by official or legal authority to practice a profession within a designated scope of practice
- Most appropriate level of PA regulation
licensure
98
- Official list of persons who have met legal requirements to practice
- No assurance that providers are qualified
registration
99
- Verifies that a professional has met specific competencies through an assessment
- Usually, a non-regulatory body
- Ex: PANCE/PANRE
certification
100
What types of licenses can you get? describe them
- license to practice: includes both practice and prescriptive authority
- license to prescribe: will need this if not included in practice license
101
Describe state statutes and administrative roles
- state statutes - laws telling you what you can and cannot do
- administrative roles - can give you rules more struct that the state statutes
102
What are the 2 tiers of hospital credentialing and privilege processes?
- tier one: verification of primary credentials and competence
- tier two: delineation of privileges, appointment, and reappointment
103
What does this describe:
Submit application, verification of credentials, core competency evaluation, peer evaluation, focused professional practice evaluation (period of time in which new providers or new privileges are monitored)Submit application, verification of credentials, core competency evaluation, peer evaluation, focused professional practice evaluation (period of time in which new providers or new privileges are monitored)
tier one privileging process
104
What does this describe:
Credentialing committee reviews application and FPPE, considered request for privileges, executive committee determines in privileges will be granted or denied, health system governing body final recommendations
tier two privileging process
105
What fundamentals should be considered when developing an effective PA/physician team/healthcare team?
- mutual respect
- understanding state statutes and regulations
- understanding of PA scope of practice
- recognition of one's strengths and weaknesses
106
What is the difference between DOs and MDs?
- body is the unit
- more holistic care
- focus on primary care and preventative medicine
- treat the host/patient not the disease
107
What are the different primary care specialties? What services are provided in these areas?
- family medicine: pregnancy to geriatrics, acute/chronic illnesses (diabetes, HTN, kidney disease)
- internal medicine: adolescence to geriatrics; manage multiple, chronic diseases
- pediatric care: infants to adolescence; outpatient and inpatient settings (immunizations; surgery, ICU)
- women's health: annual exams, breast disease, cancer screening, STD, ultrasound
108
What are the principles of team-based care?
- shared goals
- clear roles
- mutual trust
- effective communication
- measurable process and outcomes
109
What are the different elements of team-based care?
- patient and family
- more than 1 clinician
- mutual goal
- close coordination
- clear communication
110
What are the different roles of a healthcare team?
- patient/family members
- physicians
- PAs
- Nurses
- therapy
- respiratory therapy
- pharmacists
- patient care manages (social workers)
- paramedics/EMTs
- religious/spiritual representatives
111
What is this describing:
- Organized approach to delivering primary care
- Focus on preventative care versus costly care of disease/illness
patient-centered medical home
112
What are the principles of the patient-centered medical home?
- Primary care provider
- Team-based care
- Patient needs are considered holistically
- Integrated and coordinated care
- Quality and safety
- Accessibility
- Affordability
113
- Learned and shared knowledge that specific group use to generate their behavior and interpret their experience to the world
- Age, gender, class, race, ethnicity, religion, occupation
culture
114
- Social construct used to identify groups by physiological characteristics
- Skin color, hair, texture, facial features
race
115
Cognizant observant and consciousness of similarities and differences among and between cultural groups
cultural awareness
116
What does cultural competence include?
- Understanding of what culture is and is not
- Insight into intracultural variation
- How individuals identify with their culture, including personal and community health
- Conscious of own perceptions and biases
- Reactions to other cultures
117
occurs automatically and unintentionally; affects judgments, decisions, and behaviors
implicit bias
118
verbal behavioral, and environmental indignities that are hostile, derogatory, negative and results in insulting another individual; awareness is key
microaggressions
119
What are the benefits of cultural awareness?
- Decreasing barriers → decreasing disparities
- Improved patient care
- Increased patient satisfaction
- Decreased malpractice costs
- Compliant with legal requirements
- Positive community image
120
What is the cultural competence model of care (ASKED)?
- awareness (self-examination)
- skill (cultural assessment gathering data regarding present problem, then conduct physical assessment)
- knowledge (obtaining information)
- education (modifying existing beliefs)
- desire (engage in process of becoming culturally aware)
121
What are some healthcare barriers?
- economic
- geographic
- social
- cultural
122
What are sources of disparities?
- patients: mistrust or refusal
- healthcare systems: location
- providers: bias/prejudice
123
What is this describing?
- Goal → improve access to health care for minorities, reduce disparities and improve quality of care
CLAS standards
124
What is the foundation of CLAS standards?
- effective care (disease prevention)
- understandable care (comprehend questions)
- respectful care (consider patient's values)
125
What is the principle standard of the CLAS standards?
Provide effective, equitable understandable, and respectful quality of care and services that are responsive to diverse cultural health beliefs and practices, preferred language, health literacy, and other communication needs
126
- Relays information exactly as presented without additions, omission, editing, or polishing
- Explains or makes word pictures of terms with no linguistic equivalent and checks for understanding
- Gives cultural framework for understanding of message being interpreted
- conduit
- clarifier
- cultural broker
127
What are the different interpreter roles?
- conduit
- clarifier
- cultural broker
128
Describe the triadic interview process?
- includes provider, patient, and interpreter
- 3 components:
**pre-session: provider and interpreter clarify visit, establish ground rules
**triadic interview
**post-interview debriefing: ensure patient understand the visit
- everything should be in a language patient can understand; translation cannot be substituted
129
Define medically underserved areas
- based on geographic location
- ratio of PCP per 1000 populations; infant mortality rate
- % of population w/ incomes below poverty level
- % of population over 65
130
What are some examples of medically underserved populations?
- homeless
- low-income/medicaid eligible populations
- cultural/linguistic barriers
- migrant workers
- native americans
131
What are some categories of provider shortages?
- primary care
- dental care
- mental health
132
What are the different type of shortages?
- geographic areas
- population groups (native american tribes)
- healthcare facilities (correctional institutions/mental health hospitals)
133
- Federal grant funding
- Serves underserved area or population
- Sliding fee scale
- Provide comprehensive services
**Medical, dental, behavioral, social services
- Ongoing quality assurance program
- Nonprofit with governing board of directors
FQHCs (federally qualified health clinics)
134
What is this describing:
- Serves high need community, comprehensive primary care services/supporting services (translation and transportation), available to all ages and residents (free adjusted to income level), governed by a community board (majority members → health center patients), performance and accountability requirements regarding their operations
CHCs (community health centers)
135
- Federal reimbursement enhanced but doesn’t receive core federal grants like FQHC
- Rural or urban areas
- Comprehensive health services
**Medical, dental, mental health, pharmacy, social services
- No specific requirements for healthcare provider
**PAs and NPs make up 15% of workforce
- Required to provide care regardless of insurance or ability to pay
- Multiple mobile units
CHCs (community health centers)
136
- Created after 1997 balanced budget act
**Provide services in areas affected by hospital closures through the 1980s and early 90s
- Reduces financial vulnerability of rural hospitals while improving access to healthcare
**Qualifies for medicare incentives
CAHs (critical access hospital programs)
137
What are the rewards of PA practice in the rural health setting?
- autonomy (higher level of confidence)
- broader scope of practice
- primary provider for community
- small-town community lifestyle
138
What are the challenges of PA practice in the rural health setting?
- professional isolation
- work/life balance
- salary/benefits
- lack of resources
139
- Occurs automatically and unintentionally
- Affects judgments, decisions, and behaviors
implicit bias
140
An unfavorable or favorable opinion or feeling that is formed without knowledge, thought, or reason
prejudice
141
- Prejudice, discrimination, or antagonism by an individual, community, or institution against a person or people on the basis of their membership in a particular racial or ethnic group, typically one that is a minority of marginalized
- The belief that different races possess distinct characteristics, abilities, or qualities, especially so as to distinguish them as inferior or superior to one another
racism
142
Verbal, behavioral, and environmental indignities that are hostile, derogatory, negative, and results in insulting another individual
microaggressions
143
- Large-scale, systematic forms of oppression of a target group by institutions of society, such as government, education, and culture
- They can manifest in the policies, practices, structures, programs, and philosophy of governmental agencies, legal and judicial systems, etc
- Can affect whole groups or classes of people
macroaggression
144
How can things just as implicit bias, prejudice, microaggressions, etc. affect health disparities?
- lower compliancy
- limits access to care
- higher rates of chronic disease
- increase discriminatory environment
145
All patients have a fair chance to achieve their highest level of health, regardless of factors like race, ethnicity, disability, gender identity, socioeconomic status, or geography
health equity
146
What is our role in addressing health disparities?
- Evaluate/question practices and policies of workplace, home, and social environment
- Join or support minority peer efforts
- Engage with local and national advocacy groups who support an increasingly diverse PA workforce
147
What are the social determinants of health? Provide examples of each type
- economic stability (employment, income, expenses)
- neighborhood and physical environment (housing, transportation, safety)
- education (literacy, language, early childhood education)
- food (hunger, access to healthy options)
- community and social context (support systems, discrimination, stress)
- health care system (health coverage, provider liability, quality of care)
148
What are the steps in developing health policy/statutes (Kingdon model)?
- external environment (interested parties; stakeholders)
- policy formulation phase (policy development)
- policy implementation phase (rule making)
- policy modification phase (changes needed to be made to existing policy)
149
What are the 6 key elements to modern PA practice act?
- licensure as regulatory term
- full prescriptive authority
- scope of practice determined at practice level
- adaptable proximity requirements (direct: physician on site; indirect: off-site)
- chart co-signature requirements determined at practice
- no PA-physician ratio (determine at practice levels)
150
- Commitment to team practice
- Eliminate legal requirements that define the required relationship between PAs, physicians, and other healthcare providers
- Create separate majority-PA boards to regulate PAs vs. adding PAs to medical boards
- Direct reimbursement by public and private insurance payers
- Provides PA to practice medicine to the full extent of education, training, and experience
optimal team practice
151
What is the process for developing legislation?
- Identify changes that need to be made
- Bill gets drafted
- Needs sponsors
- Bill is introduced to a committee (3 hearing in 2 years)
- Introduced on the floor (house and senate)
- President/governor for signature into law
152
What is the process for implementing legislation?
- Designing/establishing working agenda
- Rulemaking→defining and implementing the regulations
- Operating→implementing the rules
- Evaluating→monitoring effectiveness of regulations
153
What are the best practices for effective professional advocacy?
- meet with members in person
- touch base often
- offer to be a resource
- give examples, stories
- identify and use commonalities to build relationships
154
Examples of external environment government agencies that can act as stakeholders when developing legislation
- HHS → department of health and human services
- CDC → centers for disease control and prevention
- CMS → centers for medicare and Medicaid
- FDA → food and drug administration
- HRSA → health resources and services administration
- US department of justice
- DEA → drug enforcement agency
155
What groups fall under the HHS?
- CDC
- CMS
- FDA
- HRSA
156
What group falls under the US department of justice?
DEA
157
Combining people and organizations with the intent of promoting, maintaining, or restoring health
health care system
158
What is the function of health care systems?
- preventative care
- diagnostic care
- variety of treatment services
159
What are the resources of health care systems?
- workforce
- informatics
- medical technologies
160
What is the common goal of healthcare systems?
high quality, safe care
161
What factors can affect health systems?
- Political climate
- Economic development
- Advancements in technology
- Social and cultural values
- Physical environment
- Population characteristics
- Global influences
162
Explain the differences between primary, secondary, and tertiary care
- primary: outpatient care (common health problems, highest percentage of visits)
- secondary: inpatient (specialized care)
- tertiary: subspecialized care
163
- independent practice associations (IPA)
**similar practices/hospitals consolidate, centralize resources, develop an “on-call” system, support each other
**physicians still in charge of their practice; negotiate payer contracts as group → more bargaining power with third party payers
horizontally integrated health
164
- one organization owns all levels of care (primary to tertiary; facilities and personnel)
- large academic medical centers
- large urban hospital systems
- regional medical centers
vertically integrated health
165
- owned by investors/shareholders
- could be physician owned
- profits go to company instead of community
for profit orgs
166
- viewed as charities (usually affiliated with religious denominations)
- income exceeding expenses goes back to community
- not required to pay federal income tax or state/local property taxes
non-profit orgs
167
- Organized approach to delivering primary care
- Focus on preventative care vs costly care of disease/illness
- Principles:
**Primary care provider, team-based care, patient needs are considered holistically, integrated and coordinated care, quality and safety, accessibility, affordability
patient-centered medical homes
168
- Multispecialty groups responsible for cost-effective, high-quality care for a defined patient population
- Combines primary care and specialty care
- CMS funded program
accountable care organizations
169
- Intense rehabilitation due to injury or disease
- Goal → restore maximal function and independence
- Qualifying diagnosis → stroke, SC injury, amputation, trauma, hip fracture
- 3 hours of therapy/day 5x a week; must show progress
inpatient rehab facilities
170
Transition from acute inpatient to permanent residence (patients who need medical care, but not at the hospital level and can’t be cared for at home)
skilled nursing/long-term care facilities
171
- Designed to be short-term
- Need medical management/rehab services but don’t qualify for inpatient rehab
- No requirement for daily visits from HCP
skilled nursing
172
designed for critically ill who need complex medical care
long-term care
173
- People who need non-medical custodial care when at home care is not possible
- Assistance with ADLs (bathing, dressing, grooming, mobility, medication monitoring)
nursing homes - custodial care
174
- Cost effective way to manage injury/disease at home
- Services provides → wound care, IV meds, therapy services, monitoring disease/health status
- Not included → personal care/custodial care; patients need to pay out of pocket for these services
home health care
175
- Includes treatment of chronic illness, but also focuses on patient’s quality of life
- Initiated at any stage of an illness
palliative care
176
- Provided at end of life → 6 months or less prognosis
- Focuses on comfort and quality of life; does not include medical treatment
hospice care
177
- Accrediting/certifying body of healthcare facilities and programs nationwide
- Health care setting accreditation:
**Hospitals, home care, nursing care centers, behavioral health care, abulatory care, assisted living, etc.
- Certifications:
**Establishes evidence-based standards of care for specific programs
**Goal: improved the delivery of care
**Specific performance and accountability measures that must be met
Joint commission
178
When was the joint commission created?
1951
179
What is the general content of a medical record?
- Complete and comprehensive history and current assessment of a patient's health
- Communication between providers
- Legal record of care → insurance billing and payment; lawsuits
- Data collection → research, quality assurance
180
What should each encounter include (medical record)?
- Reason for encounter/relevant history
- Assessment, clinical impression or diagnosis
- Plan of care
- Date and author identity
- Patient’s progress
- Diagnosis/treatment codes
- Referrals
181
What are the "do not use" abbreviations as defined by the Joint Commission?
- U → unit
- IU → international unit
- QD, qd, QOD, qod → daily, every other day
- Trailing zero
- Lack of leading zero
- MS
- MSO4 and MgSO4
182
What are the components of the evaluation and management encounters?
- medical history (why you are seeing pt, chief complaint, history of illness, past medical, family, social history)
- physical examination (body areas)
- medical decision making (thought process for evaluating, diagnosing, and treating pt)
183
What are the different billing codes and what are they used for?
- ICD-10-CM: diagnosis codes (defines injury, illness, death)
- CPT: procedural codes, facility, or office setting (E/M, anesthesia, surgery)
184
What are the different parts of medicare? What services are covered under each part?
**Part A**
- No premium, already paid frough payroll taxes
- Hospital facility, equipment, supply costs, SNF
**Part B**
- Patients pay monthly premium
- Hospital, nursing homes, private offices
**Part C**
- Monthly premiums; lower copays and deductible
**Part D**
- Prescription drug coverage
- Pay a basic premium
185
What are the different medicare rules?
- incident to
- shared visit
- academic medical institutions
186
What is this describing (medicare):
- Covered under part B
- Can bill 100%
- Only applies to outpatient office visit
- Physician and PA are employed by same group
- Not a new patient visit, physician on site
incident to
187
What is this describing (medicare):
- Hospital based
- Physician can bill entire service if encounter was face to face
- Only E/M, same calendar day, physician and PA must have common employer/work
shared visit
188
What is this describing (medicare):
- Resident coverage → cannot bill PA first assist surgical fee
- Preceptors permitted to use student documentation in the patient’s chart
academic medical institutions
189
What is the goal of medicare incentive programs?
they are value based programs (better care, better health, lower costs)
190
What do medicare incentive programs include?
- Meaningful use of EMR
- Merit-bases incentive payment system (MIPS)
- Advanced alternative payment models (APMs)
- Physician quality reporting system (PQRS
191
Qualifications for medicaid
- Low-income individuals
- Families with dependent children
- Pregnant women
- Elderly
- Disabled
192
Qualifications for medicare
- Over 65
- Disabled receiving cash benefits for > 24 months
- End stage renal disease
193
What is the variability in private insurance?
- Different payers and plans
- Services being provided
- Regional coverage
- Either billed under physician or under PA
194
What are examples of unethical billing practices?
- self-referrals
- upcoding
- perform medically unnecessary procedures
- billing for services not performed
195
Failure of a planned action to be completed as intended or the use of the wrong plan to achieve an aim
medical errors
196
Error was committed, but corrected before a patient is harmed, avoided adverse event
near-miss
197
unintended physical injury resulting from or contributed by medical care that requires additional monitoring, treatment, or hospitalization, or results in death
adverse event
198
- Doing something wrong (commission)
**Negligence
- Failing to do something wrong (omission) that leads to undesirable outcome
**Failure or delay with diagnosis, misdiagnosis
error
199
Patient safety even that results in permanent, or severe temporary harm
sentinel event
200
What are the different types of medical errors that occur? Explain.
**human factors:**
- Work conditions, organizational characteristics, individual characteristics (skills, knowledge)
- Slip (carried out incorrectly), lapse (omitted or not carried out), mistake (did not work out as planned)
**system factors**
- Healthcare worker schedules
- Poor training
- Lack of supervision
- Culture that discourages cooperation and teamwork
201
What populations are most at risk to medical errors?
- elderly
- pediatric patients
- neurosurgery
- thoracic surgery
- vascular surgery
- ICU patients
202
What are some "never" events?
- Surgical or invasive procedure events (Wrong site, wrong person, wrong procedure, more invasive than intended)
- Product or device events (Use of contaminated drugs, devices, biologics)
- Patient protection events (Discharged incapacitated patient)
- Care management events (Medication errors, falls)
- Radiologic events (Metallic objects in MRI area)
- Potential criminal events (Impersonating a healthcare provider, abduction of a patient, sexual abuse of patient or staff)
203
What are some strategies you can use to decrease medical error occurences?
- safe, effective, timely health care quality
- reporting systems
- safe culture
- identifying why it happened, how it can be corrected
204
What are the components included in malpractice negligence?
- duty (must provide provider had duty to care for pt)
- breach of duty (difficult to prove, reasonable prudent care provided by other providers)
- causation (relationship between negligent act that resulted in injury)
- damages
205
Legal doctrine binding the physician to the PAs actions
physician liability
206
What are the principles of physician liability?
- respondent superior (employer responsible for employees actions)
- negligent supervision (employer fails to monitor employees actions)
- negligent hiring (employ someone with questionable background)
- captain of the ship (physician liable for actions of the employee)
- borrows servant rule (physician in control of PA; responsible for actions of the PA)
207
What are some examples of why PAs get sued?
- lack of documentation
- lack of appropriate supervision
- not referring in a timely manner
- misdiagnosis
- inadequate examination
208
Lays out values, roles, and responsibilities, approach diversity, consent, confidentiality, and details guidelines for different ethical dilemmas a PA might face
Guidelines for Ethical Conduct for the PA Profession
209
- Guidelines for how a PA student should legally conduct themselves based on certification status
- Delineates differences between PA-S and PA-C
Code of Conduct for Certified and Certifying PAs
210
Standards for what a PA should know and be competent in before graduating
Competencies for the physician Assistant Profession
211
- Bacteria in the small intestine causing fluid to pour out
- Causes watery diarrhea
Cholera
212
In 1854, (...) tried to figure out why so many people were dying in the Gold Square
area of London
Dr. John Snow
213
- Occurrence and causes of illness in:
**Populations of people and
**Development and implementation of interventions
****To prevent and control them
epidemiology
214
What is the first step in public health?
- diagnose the population
- count cases of illnesses present in a population over a defined period of time
215
No. of old and new cases during period of time/no. in the population
prevalence
216
No. of new cases diagnosed during a period of time/no. in the population
incidence
217
- counting and tracking cases in a population
**Active: when new cases are actively looked for and “reported” to public
health agencies
**Passive: health system receives reports from hospitals, clinics, etc
disease surveillance
218
What is the primary, secondar, and tertiary levels of prevention?
- primary: reduction of risk factors before occurrence of disease, condition, or injury (get vaxxed)
- secondary: detect and treat early diseases (screening)
- tertiary: treating disease to minimize impact; stop it from getting worse (treatments, therapies, rehab programs)
219
- "Out of control” event or occurrence that adversely affects people and communities
- Basic needs are greater than the resources available
disasters
220
What are examples of natural disasters?
- earthquakes
- volcano
- tsunami
221
What are examples of man-made disasters?
- fire
- building collapse
- terrorist attack
222
What are some consequences of disaster?
- death
- injury
- loss of shelter
- spoilage of food
- loss of electricity
- loss of transportation
- looting of stores
- inability of EMS to come to you
223
What is the process of disaster management?
- preparedness: activities prior to disaster (warning systems)
- response: activities during a disaster (search and rescue)
- recovery: activities following a disaster (temporary housing)
- mitigation/prevention: activities that reduce the effects of disasters (public education)
224
What are the different disaster responses? Explain
**Activation**
- Notification and initial response
- Disaster scene assessment
- Immediate activation of command structure/group
**Implementation of disaster interventions**
- Search and rescue
- Extrication, triage, stabilization, and transport
- Decontamination
- Definitive scene management
**Recovery**
225
How do communities prepare for disaster?
*they make plants for what they will do, requires assembling of "stakeholders"*
- local and state govt, hospitals and medical personnel, law enforcement
*once stakeholders are assembled, a strategic plan is made*
- maps out: who? does what? when? etc
226
What would be important in a disaster strategic plan?
Policies and procedures for:
- Training/practice before disaster
- Evacuation planning
- Developing surge capacity
- Supply chain resources
227
What are the 3 methods of disaster training and practice?
- virtual
- table-top
- full scale
*communication training*
228
Begins with recognition of developing event
- Ex. Member of public calling 911
- Some are tracked, such as hurricanes and tornadoes
initial disaster response
229
Includes direct confirmation of the disaster by EMS, law enforcement and/or fire
- First responders “size up” the situation
- First responders initiate “incident command system”
prehospital response and early scene management
230
Led by “incident commander” – lead first responder; Incident commander “sizes up” disaster by making estimates on:
- Needed resources
- Number of victims
- Need for triage
initiation of incident command
231
What are the key positions in the incident command structure in a disaster?
- EMS commander (oversight of EMS)
- EMS operations officer (oversees direct operations)
- Triage officer (responsible for ensuring patients are identified, triages, moved to treatment or morgue)
- Treatment officer (treatment)
- Transport officer (getting patients transport)
- Staging officer (organizing a staging area for vehicles)
232
What happens in the prehospital triage?
- patients counted, evaluated, classified by severity
233
What are some problems with prehospital triage?
- too many patients, exceeds number of ambulances
- hospitals overwhelmed
- normal patient care modified to "do most good for most people"
234
After triage, patients are moved to
a designated treatment area with
color-coded areas, what do the colors mean?
- red: immediate
- yellow: delayed
- green: minimal
- black: expectant/unresponsive
235
- Mobile medical units can be set
up to allow treatment for (...)
- In treatment area: (...)
- minor conditions
- Airway management, IV therapy, Medications
236
What is the hospital response to disasters?
- operating room prep
- staff call back critical
- supply chain ramp up
- patient re-triage
- set up alternative care sites
- resupply equipment
- patient disposition
- early on- activation of hospital incident command system
237
“Winding down the disaster response”
demobilization
238
What is the recovery phase of a disaster?
restore community back to normal:
- repair infrastructure
- temporary housing
- ongoing long-term care for patients
- recovery programs
239
Describe the mitigation (final) phase of a disaster
improving preparation for next disaster:
- changes to building codes
- improved warning systems
- public education
- creation of strategic stockpiles
240
Ensures that “every working man and woman in the United States has a safe and healthful working conditions”
Occupational safety and health act (OSHAct) of 1970
241
What did the OSHAct create?
- OSHA (Occupational Safety and Health Administration)
- NIOSH (National Institute of Occupational Safety and Health)
242
What was the result of OSHA and NIOSH?
- Physicians and other practitioners were trained in occupational medicine
- Research in OM was funded
- Occupational practitioners began involvement in making workplaces healthy and safe
243
- Among the 5 leading causes of morbidity and mortality in the U.S
- Account for up to half of all injuries in some age groups
- Cause 3.8 million disabling injuries per year
- Cause 4,500 workplace deaths per year
occupational injuries and illnesses
244
What are some occupational injuries and illnesses?
- Asbestos-related mesothelioma (increasing still)
- Fatal hypersensitivity pneumonitis (increasing)
- Include 15% of new-onset, work-related asthma
245
- Often missed!
- Not suspected, asked about, or screened for
- Workplace exposures are not known to medical folks
- No one asks patients about workplace exposures
occupational diseases
246
What questions could we ask out patients via a "quick occupational health survey?"
- What kind of work do you do?
- Are your symptoms better or work when you're at home or work
247
If "quick occupational health survey" yields any positives, what should you do?
1. self-administered questionnaire (chronology of jobs, exposure survey)
2. review exposures identified or suspected from results of questionnaire
3. think about possible links between suspected exposures and symptoms patient has
248
What should you include when looking at a persons occupational history?
- job title
- duration of job
- description of job
- exposures
- protective equipment used
- duration and intensity of exposure
249
What are some common workplace injuries/illnesses reported to Bureau of Labor Statistics?
- sprains, strains, tears
- MSK disorders
- overexertion
- general soreness and pain
- bruises and contusions
- cuts, lacerations, punctures
- fractures
- multiple injuries and disorders
- back pain
- heat burns and scalds
250
What are the top 3 occupations with work injuries?
- fishers
- logging workers
- aircraft pilots
251
What are the top 3 occupations with fatal injuries?
- construction
- transportation and warehousing
- fishing/hunting
252
What occupational problem is very common and is triggered by simple irritation or immunological attack?
skin diseases/contact dermatitis
253
- What can cause irritant contact dermatitis?
- What is its mechanism?
- soaps, water, acids, organic solvents
- non-immunogenic damage to the barrier function of the stratum
corneum of the skin and/or direct damage to deeper layers of skin cells
254
What type of irritant contact dermatitis is this:
- single exposure can be strong enough to produce a response
- hands usually involved
- happens over minutes/hours/few days
- redness, pustules, blisters
acute irritant contact dermatitis
255
What type of irritant contact dermatitis is this:
- inflamed skin is sharply demarcated from surrounding normal skin
- crackling, chapping, bleeding, itching, burning
- happens over a few weeks//months
subacute irritant contact dermatitis
256
If exposure to irritant continues in contact dermatitis, what can occur?
- Skin dryness
- Hyperkeratosis – increased thickness
- Skin wrinkling
- Sometimes can lead to immune system attack (allergic reaction)
257
What are common allergens in allergic contact dermatitis? Mechanism?
- chromates, biocides, fragrances, rubber chemicals
- mechanism: IgE mediated (type 1 hypersensitivity)
258
What are clinical features of allergic contact dermatitis?
What happens if exposure to allergen continues?
- rash begins 24-48 hours
- pruritis
- erythema
- raised lesions: papules, vesicles, blisters
- if exposure continues: skin becomes thick, dry, and fissured
259
What are acute respiratory diseases that can be caused by inhaled workplace substances?
- Laryngitis
- Bronchoconstriction
- Pulmonary edema
- Rhinosinusitis
260
What are chronic respiratory diseases that can be caused by inhaled workplace substances?
- Asthma
- Pulmonary fibrosis
- Lung cancer
- Bronchitis
261
What we breathe into our body goes to different areas depending on:
- Water solubility
- Particle size
262
exposures can “flare up” any “regular” asthma a patient has
work-aggravated asthma
263
Exposures can directly cause asthma in a patient who does
not have pre-exisiting asthma
occupational asthma
264
When should you think of possible occupational asthma?
- When dyspnea, wheezing, or coughing correlates with workplace exposure
- When patient feels better during evenings, weekends, vacations
- When symptoms occur 4-8 hours after exposure to suspected substance
