HealthCare Administration Discussion
2nd group of Questions 1. As a Healthcare Administrator what is your opinion on the current situation of the Corona virus? 2. Do you feel it has been handled appropriately from a medical aspect? Why or Why not? 3. Why do you think so many healthcare facilities were not prepared with the needed equipment and PPE? (Person Protective equipment)? 4. What do you see as the biggest problem Healthcare Administrators will not face moving forward? 5. What would you have changed as an administrator? 6. Do you feel this class gave you an understanding of the healthcare needs of hospitals and long term facilities based on the diseases we discussed in class? Discovering or proposing what is right/wrong or good/bad Autonomy honors patients’ right to make their own decisions. Beneficence helps patients advance their own good. Nonmaleficence does no harm to patients. Justice ensures that patients are treated equally, fairly and impartially. The difference between legal and ethical issues ……division of the core areas of law and ethics. Law controls what people can and cannot do. Ethics are moral standards that govern what people should or should not do. Legal regulations prohibit people from carrying out certain tasks, that are considered morally permissible actions. (adm. Life-saving support) Some laws generate disagreement among citizens, particularly over sensitive issues (end of life care….medical treatment for certain conditions). Providing medical treatment or failing to do so, is a controversy concerning law and ethics.(elderly nursing home patient with a DNR). HealthCare Administration Discussion Improving Access to Care Protecting Patient Privacy and Confidentiality Building and Maintaining a Strong Healthcare Workforce Marketing Practices Care Quality vs.
HealthCare Administration Discussion Efficiency Medical Errors End of Life Confidentiality Resource allocation Artificial Intelligence Reducing the human and financial cost of medical errors is an ethical priority but it is in the hundreds of thousands in the United States It is a leading cause of death. Clinicians have an ethical obligation to be open about their medical errors but OFTEN the personal and professional consequences of honesty can be devastating? WHY? The reality is that some medical errors are never disclosed The population is aging and our ability to keep desperately sick people alive is ever-increasing. Should we help people who want to end their lives? Physician Assisted Suicide (PAS) or Euthanasia › Oregon/ Washington/ Vermont/ › Practice restricted to physicians….not proven they are the only ones competent to provide such assistance › World Medical Association prohibits members Death Cafes/ Hospice/ Palliative Care Doctors have an obligation to keep their patients’ secrets. Can this ever be breached? › a victim of domestic abuse › bus driver with epilepsy › patient has a serious genetic disease The Health Insurance Portability and Accounting Act (HIPAA) …… specific laws that govern the release of a patient’s medical information. These laws state clearly the type of patient information released to third parties … which information must be kept confidential. The laws set forth who can see the information and who cannot. These laws appear straightforward, …grey areas such as when withholding information about a patient’s condition would be unethical because it could harm the patient or someone else. How much money should HEALTHCARE facilities receive from the government? How much should be given to each condition? › 90% of health results from ‘environment, genes and lifestyle’ swallows up funds that would do much for health if invested in education, housing, poverty reduction, the environment, community development’. AI software already interpreting the scans of radiologists, making treatment plans, and assisting surgeons in the operating theatre. How can doctors obtain informed consent from patients if no one quite understands how the AI’s self-learning algorithm works because it is too complicated, or when the error rate is unknown? What if the algorithm contains or develops biases, discriminating against certain types of patients: the young, the old, the rich, the poor, men or women? Who will be to blame, if anyone, if the AI proves malfunctions? Health is considered a human good because it helps people to have a desired quality of life and achieve life goals. Is there any difference between moral and ethical? • Overarching goals – Obtain high quality, longer lives, free of preventable diseases, disability, injury, and premature death – Achieve health equity, eliminate disparities, and improve the health of all groups – Create social and physical environments that promote good health for all – Promote quality of life, healthy development, and healthy behaviors across all life stages Situation in which a choice must be made between 2 or more equally undesirable options Example Aims to forestall ethical problems before they start Requires the health promoter to envision potential problems and institute action Ex-Patient Self Determination Act › health care institutions to provide information about advance health care directives to adult patients upon their admission to the healthcare facility. This law does not apply to individual physicians. Patient autonomy(self rule) most basic right In public health individual freedom may be limited by the duty of protecting the health and safety of society (vaccinations) Medical professions may declare certain decisions as a life-threatening risk and nonnegotiable Genetic testing/ Boy or Girl? Conflicts with caregivers DNRs Mental Health Physicians selecting patients Reporting a colleague Respecting religious beliefs Provider burnout Ethical issues in healthcare aren’t always black and white. Something made be considered “unethical” or simply frowned upon, it could still be permissible from a legal standpoint. Health Problems Spring 2018 Respiratory System Respiratory Illnesses • Asthma & COPD are significant public health burdens (Flu currently) • 1 in 7 older adults has some form of lung disease • Approximately 15% of middle aged adults • Burden of respiratory diseases affects individuals, families, schools, workplaces, neighborhoods, cities, and states • Cost falls on society and is paid for with higher insurance rates, lost productivity, and tax dollars INFLUENZA Viral infection which attacks the respiratory system———nose, throat and lungs.) Type A, B, and C Not the same as “Stomach flu” that cause vomiting and diarrhea Can be deadly CDC (3000 to 49000 deaths/year, 200,000 hospitalizations) High risk patients: Children under 5 esp under 2 Adults older than 65 Nursing home and long term facilities (residents) Pregnant women & those up to 2 weeks postpartum Weakened immune systems Chronic illnesses, Asthma, heart disease, kidney disease, diabetes Very obese, Body mass index (BMI) of 40 higher SYMPTOMS • Can resemble a common cold—–runny nose, sneezing, sore throat. • Comes on suddenly—feel worse than a cold • Fever over 100.4 F • Aching muscles, esp. back, arms, legs • Chills & sweats • Headache • Dry, persistent cough • Fatigue & weakness • Nasal congestion • Sore throat CAUSES/PATH • Travels through air in droplets • Inhale the droplets directly or pick up germs from an object (telephone, key board) • Transfer to nose, eyes, or mouth • Usually contagious a day or so before symptoms appear until about 5 days after symptoms begin……….some people 10 days • Influenza virus constantly changing…..new strains appear regularly • If you have experienced the flu before you have built up antibodies to that particular strain….if another similar strain is encountered those antibodies may prevent infection or lessen its severity • But antibodies can’t protect you against new influenza subtypes that may be different • Vaccination the best defense COMPLICATIONS If a healthy person without any other chronic illnesses should feel better in 1-2 weeks Otherwise can lead to more serious illnesses. • Pneumonia—most • Bronchitis • Asthma • Heart • Ear flare-ups problems infections • Sepsis serious Treatments • Antibiotics for bacteria, the most common cause of the condition • Get plenty of rest. Drink plenty of fluids to prevent dehydration. • Take care of your cough if it is making it hard for you to rest. A cough is one way your body gets rid of the infection. And you should not try to stop your coughing unless it is severe enough to make breathing difficult, cause vomiting, or prevent rest. COST • Flu shot $35 • $87.1 lost ea.yr. from US economy due to flu • $16.3 business loss annually • Last year 70 million work days missed due to flu • Physician visit with ins. $130/ without $100 plus out of pocket • Tamiflue/Relenza • Other • 1/3 without ins over $100/10day dose medications/remedies $5-100. of population will spend $250-$1000 Influenza vaccination • Flu vaccines cause antibodies to develop in the body about two weeks after vaccination. These antibodies provide protection against infection with the viruses that are in the vaccine. • The seasonal flu vaccine protects against the influenza viruses that research indicates will be most common during the upcoming season. • Traditional flu vaccines (called “trivalent” vaccines) are made to protect against three flu viruses; an influenza A (H1N1) virus, an influenza A (H3N2) virus, and an influenza B virus. • There are also flu vaccines made to protect against four flu viruses (called “quadrivalent” vaccines). These vaccines protect against the same viruses as the trivalent vaccine and an additional B virus. Types of vaccinations 2016-17 • CDC recommends use of injectable influenza vaccines (including inactivated influenza vaccines and recombinant influenza vaccines) during 2016-2017. • The nasal spray flu vaccine (live attenuated influenza vaccine or LAIV) should not be used during 2016-2017. • trivalent (three-component) vaccines will be available. and quadrivalent (four-component) flu Trivalent • Standard-dose trivalent shots (IIV3) that are manufactured using virus grown in eggs. Different flu shots are approved for different age groups. Most flu shots are given in the arm (muscle) with a needle. One trivalent vaccine formulation can be given with a jet injector, for persons aged 18 through 64 years. • A high-dose trivalent shot, approved for people 65 and older. • A recombinant trivalent shot that is egg-free, approved for people 18 years and older. • A trivalent flu shot made with adjuvant (an ingredient of a vaccine that helps create a stronger immune response in the patient’s body), approved for people 65 years of age and older (new this season). Quadrivalent • Quadrivalent flu shots approved for use in different age groups. • An intradermal quadrivalent flu shot, which is injected into the skin instead of the muscle and uses a much smaller needle than the regular flu shot. It is approved for people 18 through 64 years of age. • A quadrivalent flu shot containing virus grown in cell culture, which is approved for people 4 years of age and older (new this season). Who should not get vaccine • Children younger than 6 months are too young to get a flu shot. • People with severe, life-threatening allergies to flu vaccine or any ingredient in the vaccine……. This might include gelatin, antibiotics, or other ingredients. • See Special Considerations Regarding Egg Allergy for more information about egg allergies and flu vaccine. Is it too late ??? • Flu vaccination should begin soon after vaccine becomes available, if possible by October. • However, as long as flu viruses are circulating, vaccination should continue to be offered throughout the flu season, even in January or later. Pneumonia Respiratory infection that inflames the air sacs in one or both lungs. The air sac may fill with fluid or pus, causing cough with phlegm or pus, fever, chills, and difficulty breathing. Symptoms of pneumonia caused by bacteria in otherwise healthy people younger than 65 usually come on suddenly. They often start during or after an upper respiratory infection, such as the flu or a cold. May be mild or severe. Many organisms ….. Bacteria, viruses and fungi Symptoms may include: • Cough. Mucus may be rusty or green or tinged with blood. • Chest wall pain that is often made worse by coughing or breathing in. • Fever, which may be less common in older adults. • Shaking, “teeth-chattering” chills. • Fast, often shallow, breathing and the feeling of being short of breath. • Fast heartbeat. • Feeling very tired or weak. • Nausea and vomiting. • Decreased appetite CAUSES/PATH • Bacteria and viruses in the air we breathe. It is classified according to the types of germs that cause it and where you got the infection. • Community acquired—Most common type. Occurs outside of hospitals or other healthcare facilities. Caused by Bacteria—Streptococcus pneumoniae…..Can occur on its own or after cold or flu. May affect one part of lung (lobar). Bacteria like organism—Mycoplasma…walking pneumonia…milder symptoms Fungi—chronic problems…soil, bird droppings (geographical) inhale large doses Viruses—most common cause in children…usually mild (same viruses colds/flu) Hospital acquired—Causing bacteria can be resistant to antibiotics….people already sick…ventilated patients at high risk Health care acquired—bacterial…….long term facilities/ outpatient clinics such as dialysis centers…..can be more resistant to antibiotics Aspiration—-occurs when inhale food, drink, vomit, or saliva into lungs. More likely if gag reflex disturbed. (excessive alcohol, brain inj, swallowing problem Pneumonia comparison normal pneumonia RISKS FACTORS • Being hospitalized • Chronic disease—asthma, COPD, heart disease • Smoking • Weakened or suppressed immune system COMPLICATIONS • Bacteria in the bloodstream (bacteremia)…..can spread infection to other organs, potentially causing organ failure • Difficulty breathing…..not getting enough oxygen do to underlying lung disease. • Fluid accumulation around the lungs(pleural effusion)…..build up in the space between layers of tissue that line the lungs and chest cavity (pleura). If the fluid is infected may need a chest tube. • Lung abcess….pus formed in a cavity of the lung…..treated with antibiotics….sometimes surgery or drainage needed PREVENTIONHealthCare Administration Discussion • Get vaccinated • Make sure children get vaccinated • Practice good hygiene • Don’t smoke • Keep your immune system strong Pneumonia vaccinations • PCV13 (Prevnar) for Infants, Children, and Adults recommended for all adults 65 years or older. One dose of PCV13 is also recommended for adults 19 years or older with conditions that weaken the immune system, such as HIV infection, organ transplantation, leukemia, lymphoma, and severe kidney disease. If you have one of these conditions, talk to your doctor. • PPSV23 (Pneumovax) for Children and Adults protects against 23 types of pneumococcal bacteria. It is recommended for all adults 65 years or older and for those 2 years or older at high risk for disease. PPSV23 is also recommended for adults 19 through 64 years old who smoke cigarettes or who have asthma. Vaccination • Before the vaccine, there were about 700 cases of meningitis, 13,000 blood infections, and 200 deaths from pneumococcal disease each year among children younger than 5 years old. After the vaccine was introduced, these numbers dropped quickly. Asthma $20.7 billion (NIH, 2009) Inflammatory disease of the bronchial tubes of the lungs Asthma • Characterized by episodes of reversible breathing problems from narrowing airways • Symptoms Wheezing Cough Chest tightness Short of breath • Risk factors Parent with asthma Sensitization to irritants/allergens Respiratory infections in childhood overweight Asthma Asthma • Affects people of all races, sex and age • Most significant disparities Low-income Minority populations • Higher rates of asthma Children Women and boys African Americans Puerto Ricans Below Federal poverty level Employees with certain exposures in workplace Asthma Attack • https://youtu.be/uGMSnytbmA8 • https://youtu.be/poIKEY-A0Yo • https://youtu.be/PzfLDi-sL3w Asthma • Treatment •Inhalers- emergency (Short-acting beta2-agonists) •Allergy shots- build up immunity to triggers •Steroids-help with inflammation COPD • Affects more than 13.6 million adults in US (diagnosed) • 4th leading cause of death in US • Approximately equal amount undiagnosed • Preventable and treatable disease • Airflow limitation that is not fully reversible • Progressive disease process COPD • Genetic factors influence development of disease • Smokers- but not all 85% are related to smoking • Air pollution • Chemical fumes • Dust or irritants • Flare ups most often caused by an infection Symptoms of COPD • Shortness of breath • Cough • Mucous production • Symptoms develop slowly and progress Trouble catching your breath Difficulty breathing at rest • Develop other problems Strain on heart Edema in ankles, feet, or legs COPD http://www.webmd.com/lung/lung-diseases-overview CXR Normal CXR COPD Comparison Normal COPD Tests Breathing testPulmonary function testing Xrays Spirometry • http://www.webmd.com/lung/video/diagnosing-copd Treatment • Medications • Special exercise programs- Pulmonary Rehabilitation • Oxygen • Surgery • Flu and pneumonia vaccinations Viral illnesses • Influenza • Pertussis Early symptoms can last for 1 to 2 weeks and usually include: Runny nose Low-grade fever (generally minimal throughout the course of the disease) Mild, occasional cough Late stages Paroxysms (fits) of many, rapid coughs followed by a high-pitched “whoop” Vomiting (throwing up) during or after coughing fits Exhaustion (very tired) after coughing fits Pertussis vaccination • Diphtheria, tetanus, and pertussis (DTaP) vaccines • Tetanus, diphtheria, and pertussis (Tdap) vaccines Pertussis • https://youtu.be/31tnXPlhA7w Questions • Have a good night! Major Health Problems of Today Top Health Problems in America according to Mayo Clinic Heart Disease Cancer Stroke Respiratory Illness Injuries Diabetes Alzheimer’s Disease Influenza and Pneumonia Kidney Disease Septicemia Obesity Causes of Death Heart Disease Cancer Lower Resp Disease Accidents Stroke Alzheimer’s Disease Diabetes Influenza & Pneumonia Kidney Disease Suicide Chronic Disease CDC defines Chronic disease: one that persists more than 3 months or more Cannot be prevented by: vaccines cured by medications nor do they disappear Caused by health damaging behaviors Tobacco/alcohol/ sedentary life/ eating habits Heart Disease Most common Largest number of deaths for men and women each year Kills more people than all forms of cancer combined Highest cost chronic disease Average cost: $317 billion annually One adult dies every 40 seconds in the US from a form of CVD ( such as MI) 31% of all US deaths each year Cancer Lung cancer is responsible for most deaths in both men and women Women affected by breast and colorectal cancer Every year- 1.5 million Americans are DX 500,000 deaths from CA Cost $171 billion annually- effects 1 in 2 people in their lifetime Cost relate to early test & detection/ promoting awareness/ preventive techniques/ other activities for prevention Most expensive chronic disease to treat in US Stroke Number 3 cause of death in women and number four in men Medical expenses of $33 billion annually 5% of death in US or 130,000 deaths/year One of leading causes for long term disability Usually caused by other chronic conditions, such as high BP or Cholesteral Respiratory Diseases Bronchitis and emphysema= COPD (chronic obstructive pulmonary disease) Smoking is the largest risk factor Cost $300 billion/year Expenses $170 billion/ indirect costs $156 billion Smokers develop chronic conditions such as HYTP, CA, CVD Asthma 25 million people/ $56 billion per yr. –loss of work and school absences Influenza–Can be deadly CDC (3000 to 49000 deaths/year, 200,000 hospitalizations) $87.1m lost ea.yr. from US economy due to flu …. $16.3 business loss annually ….Last year 70 million work days missed due to flu Injuries “all-time high.” 442/day Leading cause of fatal injuries in men and women is motor vehicle accidents Seatbelts, alcohol and inattention are major risk factors Today unintentional drug overdoses, falls, drowning and choking’s. 172,000plus deaths per yr The total death rate for 10- to 19-year-olds but suddenly soared 12% between 2013 and 2016… traffic accident fatalities, drug overdoses, homicides, and suicides Alcohol related deaths 88,000 annually… Cost $249 billion/yr.. Excessive alcohol use shortens lives by 30 years Diabetes Type 2 Diabetes Kidney disease Heart disease Blindness Leading cause of death in both sexes Risk factors Overweight Sedentary Lifestyle Diet Diabetes Most prevalent in the global HC industry Cost $245 billion in 2016==20% of total HC spending Today, 29 million Americans live with diabetes 86 million live with pre-diabetes Top ten leading cause of death (7) Alzheimer’s Disease Fifth leading cause of death in women and 10th in men Exact cause is not known-effects 5.4 plus million May be a link between head injuries, heart disease 6th cause of death in US Direct care expenses $236 billion—long term and hospice Indirect cost to families $223 billion- sitters Obesity $147 billion spent annually per year Major cause for chronic disease Vital to provide education, access to healthier foods, and preventive care especially to children Kidney Disease Ninth leading cause of death in men and women The overall prevalence of CKD in the general population is approximately 14 percent. High blood pressure and diabetes are the main causes of CKD. Almost half of individuals with CKD also have diabetes and/or selfreported cardiovascular disease (CVD). More than 661,000 Americans have kidney failure. Of these, 468,000 individuals are on dialysis, and roughly 193,000 live with a functioning kidney transplant. Septicemia Blood poisoning 10th leading cause of death in women Usually a complication of bacterial infection such as urinary tract or lung Prevention Handwashing Seek medical attention for any infection Awareness Vaccinations So let’s put some together Heart disease & Hypertension Stroke, Alzheimer’s Disease and other neuro Respiratory Diseases, pneumonia, influenza, and septicemia Diabetes, thyroid, and kidney disease Injuries/Trauma/Other Human Cost of Chronic Disease The human cost of chronic diseases cannot be ignored American healthcare payers face huge financial pressure due to the cost. CMS : US healthcare spending reached an estimate $3.3 trillion in 2016 up 4.3% from 2015. The spending has increases 2% plus each year since 2015. 2018 estimated 18 plus % of the Gross domestic product A significant part of this spending is on the treatment, management, and prevention of chronic diseases. Chronic cont……. Half of all Americans = one or more 1 in 4= two or more Chronic diseases cause 7 out of every 10 deaths.1 Chronic diseases such as diabetes, cancer, and heart disease are the leading causes of disability and death in the US. About 25% of people with chronic diseases have some type of activity limitation. Difficulty or needing help with personal tasks such as dressing or bathing. It may also mean being restricted from work or attending school.9 Prevention necessary 86% of spending covers people with chronic medical conditions Direct medical costs for CD exceeds $750 billion annually Milken Institute predict = increase b7 42% by 2023 costing $4.3 trillion in healthcare treatment Health insurance co-pays and out-of-pocket expenses continue to rise. In many cases, choices and care are limited or prevent care The disabling and long-term symptoms that come with chronic diseases add to extended pain and suffering. This decreases the overall quality of life.
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