Which of the following is a force for future change in healthcare service delivery?

Rationale:

A. Prospective Payment System (PPS): PPS was introduced in the 1980s and aimed to control healthcare costs by reimbursing hospitals based on predetermined rates for services provided. While it had an impact on hospital operations, it did not directly contribute to the growth of hospitals.

B. The growth of managed care: Managed care emerged as a significant force in healthcare delivery in the latter part of the 20th century, but its impact on hospital growth was more complex, including efforts to control costs and utilization.

C. Technological advances: Advances in medical technology, such as diagnostic imaging, surgical techniques, and pharmaceuticals, played a significant role in the growth of hospitals by expanding their capabilities to diagnose and treat a wider range of conditions.

D. Increased use of skilled nursing: While skilled nursing facilities and services are important components of the healthcare system, they did not directly contribute to the growth of hospitals during this period.

Rationale:

A. Indicates higher performance and better clinical and health outcomes: Quality in patient care refers to the degree to which healthcare services improve patient outcomes, prevent harm, and achieve desired clinical results. It encompasses aspects such as effectiveness, safety, timeliness, efficiency, equity, and patient-centeredness.

B. Medical practice guidelines: While medical practice guidelines are important tools for guiding clinical decision-making, they are not synonymous with quality in patient care, which involves broader considerations of performance and outcomes.

C. Constitute a plan for managing a clinical problem based on evidence: This describes evidence- based practice, which is an important aspect of delivering high-quality care but does not encompass the entirety of quality in patient care.

D. Provide protocols to guide physicians' clinical decisions: Clinical protocols and guidelines can help standardize care and improve consistency, but they are not the sole determinant of quality in patient care, which encompasses broader dimensions of performance and outcomes.