Explain why insurance companies (which are considered payers) should or should not pay (reimburse) for injuries, extended costs,

Explain why insurance companies (which are considered payers) should or should not pay (reimburse) for injuries, extended costs,

Learning Goal: I’m working on a nursing question and need an explanation and answer to help me learn.

WRITE 6 PAGES

ON BOTH THE INTERRELATIONSHIPS OF SOCIO-CULTURAL INFLUENCES IN HEALTHCARE AND HEALTHCARE DELIVERY AND QUALITY CASE STUDY

3 PAGES EACH ON APA STYLE

Part 1 (3 pages)

THE INTERRELATIONSHIPS OF SOCIO-CULTURAL INFLUENCES IN HEALTHCARE

Within this activity, you will explore how determinants of health such as poverty, behavior, education, and income are related. One common element underlies poor health: poverty. Money is required to purchase the essentials of health such as food, clothing, shelter, clean water, education, and access to preventative health services. Each day in nursing, you are faced with persons from varying economic, social, and cultural backgrounds. In addition to varying backgrounds, you will also experience differing patient values and preferences related to their individual health and behavior. Caring for the vulnerable, at-risk, and aging populations is an essential competency for nursing. Therefore, we need to explore the interrelationships of socio-cultural influences, behavioral influences, as well as economic and non-economic barriers to healthcare to improve our knowledge. In doing so, we will be able to plan specific interventions designed to help achieve healthier outcomes. You will have the opportunity to examine poverty, behavior, and other determinants of health in Sentinel City®. As providers of care, BSN nurses need to understand how these are related and impact the health of our patients.

Activity Instructions:

  1. Review course textbook and other resources.
  2. Review World Health Organization (2017). The determinants of health. Retrieved from http://www.who.int/hia/evidence/doh/en/
  3. Review Healthy People 2020 (Jan 25, 2017). Health Determinants. Retrieved from Determinants of Health | Healthy People 2020
Determinants of Health | Healthy People 2020What makes some people healthy and others unhealthy?How can we create a society in which everyone has a chance t…

Review Sentinel City® demographics and neighborhood demographics. Meet with Mayor Hill who can provide some information about Sentinel City® economics. Enter Sentinel City® and begin the bus tour. After touring Sentinel City, select a specific vulnerable or minority population group and identify one of the most common diseases, chronic condition, injury, or health concern that impacts your population group. Then list a total of 3 determinants of health from the Healthy People website. During your tour of the city, describe 1 observation related to the 3 selected determinants of health. (a total of 3 observations must be described). Note indicators of high or low employment. Consider education levels, number of female head of households, and median household incomes for example. Finally, describe a total of 3 strategies or evidence-based recommendations to help reduce or eliminate the selected observations noted during your Sentinel City® tour.

Part 2 (3 pages)

HEALTHCARE DELIVERY AND QUALITY CASE STUDY

Landmark studies To Err is Human (1999) and Crossing the Quality Chasm (2001) from the Institute of Medicine (IOM) identified medical errors are causing harm and death to almost 45,000 Americans and costing over $29 billion every year. Other studies have indicated preventable healthcare associated conditions (HACs) such as infections, sepsis, CHF, and pneumonia are main contributors for increasing the length of patient stays, the cost of care, and the likelihood of mortality (death).

Consider the below case study:

Margret Spinner-Ramirez is a 66 y/o female Hispanic-American who speaks both Spanish and English fluently. She is retired, lives alone, and has Medicaid as her primary insurance. Ms. Spinner-Ramirez was scratched by a stray cat that she feeds on her back porch daily. She has been cleaning the wound daily; however, after 2 days she went to her local ER for increased pain, redness, and swelling in her left lower leg wound where she was scratched by the stray cat. Ms. Spinner-Ramirez explained she recently had her left knee replaced about 6 months ago and verbalized new difficulty with baring weight on that extremity to the point that she was having to use her cane again. Her vital signs at the ER visit were stable. Her left leg wound was cleaned and redressed. After 5 hours in the ER, Ms. Spinner-Ramirez was discharged to home on oral Keflex for her left lower leg infection and was instructed to call her primary care physician for a follow-up appointment. Five days later Ms. Spinner-Ramirez was taken back to the same ER via ambulance. Her neighbor found her lethargic, short of breath, and was experiencing difficulty being able to move. A CT scan and blood work revealed that Ms. Spinner-Ramirez’s knee replacement in her left leg was infected secondary to the cat scratch. She was admitted as an inpatient for sepsis. She needed to have a second left knee replacement surgery with wound irrigation and debridement, which extended her inpatient stay to 3 weeks. Once she was discharged to home, she required six weeks of IV antibiotics, extensive rehab, and home health.

If you were in charge of a healthcare insurance company:

  • Explain why insurance companies (which are considered payers) should or should not pay (reimburse) for injuries, extended costs, readmissions, or death (mortality) from a hospital-acquired infection or medical error. Support your why or why not?
  • Describe two ways (initiatives) healthcare quality can be improved to help reduce errors and improve patient safety.
  • Discuss how creating incentives for providers (healthcare organizations) can improve quality and reimbursements (payments) for services/care.

Resources:

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