N108: Transition to the Registered Professional Nurse Role Study Guide Levels of health care delivery are discussed using the terms primary, secondary, and tertiary: • Primary care : The level at which a patient encounters the provider of care for the first time in an episode of illness. The setting is usually an ambulatory clinic or doctor’s office. The care usually occurs outside a hospital setting (except in cases where the clinic is located inside a hospital). The focus of primary care is health promotion and maintenance. • Secondary care: The main focus of secondary care is to prevent disease complications and restore the patient back to health. • Tertiary care : Sites involved in this type of care include long-term care facilities, rehabilitation agencies, and hospice. Hospitals as Education Institutions The education of healthcare providers is an important function of many hospitals. Although the number of hospital-based schools of nursing offering diplomas has decreased steadily, some are well supported and expect to continue operation. There are also hospital-based programs from respiratory therapy, dietetics, medical laboratory technology, and other health related occupations. Many hospitals serve as clinical laboratory sites for individuals who enrolled in colleges and universities that provide education for healthcare professionals. These individuals include students in nursing, laboratory sciences, nutrition, pharmacy, radiology and imaging, and other disciples, as well as medicine. Graduate medical education includes all the residency programs for physicians preparing for independent practice. Residents receive a salary from the hospital and are responsible for providing services in return. Residents augment the services of primary physicians, who are often referred to as the attending or staff physicians. Residents often provide the majority of medical services for individuals who are part of the medically underserved in a community, consulting with the staff physician in charge as needed. Part of the funding for graduate medical education comes from the money made available through Medicare. 2.15 Accreditation/Recognition of Healthcare Agencies A variety of standards and processes have been established to evaluate healthcare. Meeting the standards of a state governmental agency is termed approval or certification. Meeting the standards of a nongovernmental agency is usually designated as accreditation. Healthcare institutions are often certified by a government body and accredited by a nongovernment agency. In some instances, government bodies accept accreditation as the equivalent of government standards and do not require an additional approval process. Approval by a specific organization may be required for an agency to receive some type of third party payment; therefore, accreditation is important for the agencies involved. Most evaluation processes involve evaluating client outcomes, as well as the structure of the organization and the processes used to provide care. Approval may take the form of state licensing, which usually focuses on maintaining minimum standards to safeguard public health. For some agencies, this meets their needs. Additional approval is required for reimbursement under federal programs and health plans.