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Related Concept Videos

Hospitals-II00:59

Hospitals-II

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Hospitals provide inpatient and outpatient services. Inpatient services provide care to patients that stay in the hospital for an extended period, ranging from days to months. Examples of inpatient services include intensive care units, hospital wards, or surgeries. Outpatient services provide care to patients who come to a hospital for a diagnostic or treatment but do not stay overnight —for example, diagnostic tests, surgical procedures, or health education.
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Hospitals offer medical and surgical care to the sick and injured, along with accommodation while they recover. At the same time, they also provide outpatient, emergency, psychiatric, and rehabilitation services to meet various community needs. In addition to providing medical care, hospitals also act as hubs for medical research and training. Hospitals use clinical procedures and evidence-based practice standards to deliver patient care. To deliver safe and efficient care, a nurse must stay up...
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Methods of Documentation VI: Case Management Model01:15

Methods of Documentation VI: Case Management Model

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The case management model is a multidisciplinary approach that involves healthcare professionals from diverse disciplines, such as physicians, nurses, therapists, social workers, and pharmacists, working collaboratively to address the various needs of patients. Each healthcare professional brings unique expertise and perspectives, contributing to a more comprehensive understanding of the patient's condition and tailoring treatment plans accordingly.
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Methods Of Healthcare Delivery System01:26

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At the different levels of the healthcare system, we see varying methods of healthcare used. These methods include managed care systems, case management, and primary healthcare.
Managed Care System:
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Documentation in long-term care facilities and home healthcare settings is crucial for ensuring continuous, coordinated, and comprehensive care for patients. Each setting has its specific documentation processes and tools:
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A nursing care plan can present in two forms: informal and formal. Informal is a care plan for the individual use of the nurse and goals they wish to accomplish during their shift. Informal care plans are not included in the patient chart. A formal nursing care plan is a written or computerized guide that organizes patient care. It is further subdivided into two: standardized and individualized care plans. Standardized care plans are pre-populated care plans for specific patient populations,...
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Related Experiment Video

Updated: Apr 30, 2026

Improving IV Insulin Administration in a Community Hospital
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Medicare managed care plan performance: a comparison across hospitalization types.

Jayasree Basu1, Lee Rivers Mobley2

  • 1U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality.

Medicare & Medicaid Research Review
|May 7, 2014
PubMed
Summary

Medicare Advantage (MA) plans reduced preventable hospitalizations across New York, Florida, and California. However, referral-sensitive admissions varied by state, with California showing a decrease for MA enrollees.

Keywords:
Medicareambulatory care sensitive admissionselderlyhospital admissionsmanaged carepreventable hospitalizationsprimary care qualityreferral patternsreferral-sensitive admissions

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Area of Science:

  • Health Services Research
  • Public Health Policy
  • Comparative Effectiveness Research

Background:

  • Medicare Advantage (MA) enrollment has grown significantly, necessitating an evaluation of its performance relative to traditional Medicare fee-for-service (FFS).
  • Understanding the impact of MA on hospital admissions for Ambulatory Care Sensitive Conditions (ACSC) is crucial for assessing healthcare quality and efficiency.
  • Three states with high MA penetration (California, Florida, New York) provide a robust setting to examine these comparative outcomes.

Purpose of the Study:

  • To compare the performance of Medicare Advantage (MA) plans versus Medicare fee-for-service (FFS) in three high-penetration states.
  • To evaluate the impact of MA on reducing hospital admissions for preventable, ambulatory care sensitive conditions (ACSC).
  • To assess whether MA plans influence referrals for specialty procedures.

Main Methods:

  • Utilized 2004 hospital discharge data from the Healthcare Cost and Utilization Project (HCUP-SID).
  • Employed a multinomial logistic regression model to compare ACSC admissions against 'marker' and 'referral-sensitive' admissions.
  • Focused on 2004 to capture a period of significant Health Maintenance Organization (HMO) market dominance within MA plans.

Main Results:

  • MA enrollees showed significantly lower relative risk for preventable admissions in California (22%), Florida (16%), and New York (9%) compared to FFS.
  • Relative risk for referral-sensitive admissions varied: California saw a 13% decrease, while New York (37% increase) and Florida (41% increase) experienced higher risks for MA enrollees versus FFS.
  • These findings highlight state-specific differences in MA plan performance regarding different types of hospital admissions.

Conclusions:

  • MA plans were associated with reduced preventable hospitalizations in all three studied states.
  • The impact of MA on referral-sensitive admissions differed across states, with California demonstrating a lower relative risk.
  • Accounting for selection bias further strengthened the observed reductions in preventable admissions for MA enrollees in New York and Florida.