D118 Unit 2 Study Guide

Unit 2: Determining Priorities in Wellness & Health Promotion

Module Vocabulary and Key Questions

This unit focuses on systematically identifying priorities in wellness and health promotion. It covers critical concepts and questions that inform clinical decision-making, population health strategies, and evidence-based preventive interventions.

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Evidence-Based Approaches to Primary Care

What is evidence-based practice, and why is it important in healthcare?

Evidence-based practice (EBP) is a methodical approach to clinical decision-making that integrates the most reliable scientific evidence, clinical expertise, and patient preferences. The goal of EBP is to enhance patient safety, optimize health outcomes, minimize unwarranted variations in care, and promote cost efficiency. By relying on robust research, healthcare professionals ensure treatments are effective and ethically appropriate for diverse patient populations (Melnyk & Fineout-Overholt, 2019).

What are key elements of quantitative research designs and their distinguishing characteristics?

Quantitative research designs are used to systematically gather numerical data for analyzing relationships, testing interventions, and measuring outcomes. The main types include randomized controlled trials (RCTs), cohort studies, and case-control studies. RCTs, considered the highest level of evidence, utilize randomization to reduce bias and establish causality. Observational studies like cohort and case-control designs are valuable for investigating risk factors, disease prognosis, and uncommon conditions. Hierarchies of evidence and grading systems help clinicians assess the reliability and relevance of research findings.

How is evidence appraised using standard methods and grading scales?

The critical appraisal process involves multiple steps to evaluate the validity and applicability of research. It starts by clearly defining the clinical question or gap in practice, followed by a comprehensive review of the literature. Each study is assessed for methodological quality, consistency of results, and potential biases. Grading systems then rank the strength of evidence to guide informed clinical or policy decisions.

What are common models used in implementation science?

Model Name	Description
Iowa Model of Evidence-Based Practice	Helps clinicians identify problems, appraise evidence, implement interventions, and evaluate outcomes through feedback cycles.
ACE Star Model of Knowledge Transformation	Outlines five stages from discovery of knowledge to integration and evaluation in practice.
Johns Hopkins Nursing EBP Model	Utilizes the PET process (Practice question, Evidence, Translation) for rapid research application in care.
Stetler Model of EBP	Focuses on clinical judgment by combining internal data with external research evidence.

These models provide structured frameworks for translating research findings into everyday clinical practices.

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Patient-Centered Care and Value-Based Purchasing

What is the Patient-Centered Medical Home (PCMH)?

The Patient-Centered Medical Home is a primary care approach that prioritizes improved access, continuity, and coordination of care. It fosters long-term partnerships between patients and healthcare teams, involving active participation from patients and families. This model promotes safety, equity, efficiency, and patient satisfaction while reducing care fragmentation across different healthcare settings (Agency for Healthcare Research and Quality, 2020).

What is Value-Based Purchasing (VBP), and what are its goals?

Value-Based Purchasing is a payment strategy that links healthcare provider reimbursement to the quality and outcomes of care rather than the volume of services rendered. The Centers for Medicare & Medicaid Services (CMS) assesses hospitals on parameters such as patient safety, clinical effectiveness, efficiency, and patient experience. The aim is to incentivize high-quality, cost-effective care that improves patient outcomes and reduces unnecessary expenses.

What are Accountable Care Organizations (ACOs)?

Accountable Care Organizations are collaborative groups of providers responsible for the quality and cost of care delivered to specific populations, notably Medicare beneficiaries. ACOs operate under various participation models that delineate shared savings, risk-sharing, and infrastructural requirements such as health information technology and quality measurement systems.

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Transitional and Chronic Care Coordination

What is transitional care, and why is it important?

Transitional care refers to the organized coordination of healthcare services as patients move between different care settings, such as from hospital to home or rehabilitation centers. Poorly managed transitions are linked to medication errors, adverse events, hospital readmissions, and decreased patient satisfaction. Effective transitional care requires thorough discharge planning, medication reconciliation, patient education, and multidisciplinary communication.

What is coordinated chronic care, and what models support it?

Coordinated chronic care involves aligning health services across providers and settings to address the complex needs of individuals with long-term conditions. The Chronic Care Model (CCM) outlines six essential components: community resources, health system organization, self-management support, delivery system design, decision support, and clinical information systems. These elements collectively encourage proactive, patient-centered management of chronic diseases.

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Lewin’s Change Theory and Its Application to Evidence-Based Practice

What are the stages of Lewin’s change theory?

Lewin’s Change Theory describes organizational change as a three-stage process:

• Unfreezing: Preparing individuals and systems to accept change by challenging existing behaviors.
• Movement: Implementing new practices or processes.
• Refreezing: Stabilizing changes by embedding them into routine operations.

This theory is widely used in evidence-based practice initiatives to facilitate the adoption and sustainability of clinical improvements.

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Domains of Wellness

Domain	Description
Physical	Enhancing bodily health through exercise, nutrition, rest, and preventive measures.
Emotional	Supporting emotional balance, stress management, and mental health.
Spiritual	Cultivating meaning, purpose, and alignment with personal values.
Social	Building healthy relationships and engaging with communities.
Occupational	Finding fulfillment, balance, and growth in work roles.
Environmental	Ensuring safe, sustainable, and health-promoting surroundings.

These domains collectively contribute to holistic wellness.

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Risks in Transitions of Care

Transitions between care settings are vulnerable times due to potential communication breakdowns and incomplete information transfer. Common adverse outcomes include missed diagnostic results, medication errors, post-discharge infections, falls, and contradictory instructions from multiple providers. Mitigating these risks requires standardized discharge protocols and clear responsibility assignments.

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Chronic Care Coordination Models

Model	Description
Patient-Centered Medical Homes	Collaborative, team-based care focusing on chronic condition management.
Self-Management Programs	Empower patients with skills and tools to manage their symptoms and treatment.
Home-Based Primary Care	Provides healthcare services in the patient’s home via in-person and virtual visits.
Distance Chronic Disease Programs	Uses telehealth to manage chronic illnesses, especially in rural or underserved areas.

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Telemedicine: Synchronous vs. Asynchronous

Type	Description	Examples
Synchronous	Real-time interaction between provider and patient	Videoconferencing, live remote examinations
Asynchronous	Data collected and reviewed later	Store-and-forward imaging, biosignals analysis

Telemedicine enhances access to care, improves continuity, and helps overcome geographic barriers, particularly benefiting underserved populations.

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Social Determinants of Health

Social determinants of health (SDOH) include factors like economic stability, educational opportunities, healthcare access, and community resources. The Expanded Chronic Care Model integrates SDOH into disease prevention and management, acknowledging their substantial impact on health behaviors and long-term outcomes.

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National Initiatives to Improve Healthcare Quality

Prominent national efforts include:

• National Notifiable Diseases Surveillance System: A key public health tool for tracking infectious diseases.
• Healthy People 2030: Sets measurable goals aimed at promoting health equity, prevention, and addressing social determinants.

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Disease Prevention Framework

Level	Description
Primary Prevention	Preventing disease before it occurs through risk reduction.
Secondary Prevention	Early disease detection via screening to halt progression.
Tertiary Prevention	Managing established disease to prevent complications and improve quality of life.

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Palliative Care

Palliative care focuses on symptom relief, pain management, and psychosocial support for individuals facing serious illness. It can be delivered alongside curative treatments and aims to improve quality of life for patients and their families.

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Epidemiologic Triad for Infectious Disease Causation

Component	Description
Agent	The pathogenic organism causing disease.
Host	The susceptible individual at risk.
Environment	The external conditions facilitating transmission.

Disease occurs through dynamic interactions among these three components.

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Current Screening Guidelines in Adults

The U.S. Preventive Services Task Force (USPSTF) provides evidence-based recommendations for screening to detect diseases early and guide preventive care across the lifespan.

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Health Literacy, Disparities, and Culturally Responsive Care

Health literacy affects patients’ ability to engage in their care, adhere to treatments, and achieve positive outcomes. Health disparities arise when systemic barriers prevent equitable access to care. Culturally responsive care acknowledges diverse cultural beliefs and values, fostering trust and improving healthcare effectiveness for all populations.

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References

Agency for Healthcare Research and Quality. (2020). Patient-centered medical home resource guide.

Centers for Disease Control and Prevention. (n.d.). Vaccines and immunizations.

Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Wolters Kluwer.

D118 Unit 2 Study Guide.

U.S. Department of Health and Human Services. (2020). Dietary guidelines for Americans, 2020–2025.

U.S. Preventive Services Task Force. (n.d.). USPSTF recommendations.

World Health Organization. (n.d.). Health literacy.