01 Assessing Effectiveness Part 1

Question 1

In “Policy Space”, what are Occupational Hazards?

Answer 1

Dollars gained, Health lost

Question 2

In “Policy Space”, what are Surgery/Drug therapy?

Answer 2

Health gained, Dollars lost

Question 3

What are the key limitations for defining Health?

Answer 3

Measurement difficult. Mortality is marginalized. Health continuum?

Question 4

What is the Epidemiological definition for health?

Answer 4

Health definition is concise (not vague). Focuses on a measurable endpoint (mortality or survival duration)

Question 5

What are the key limitations to the Epidemiological definition of health?

Answer 5

Health encompasses more than mortality. Disease and disability are marginalized. Limited notion of value (Dead = 0, Alive = 1)

Question 6

What is the Biomedical definition of health?

Answer 6

People are healthy if they are free from disease. A disease become apparent through clinical signs and symptoms. Signs and symptoms are the result of underlying biological pathology

Question 7

What is health measured by in the Biomedical Perspective?

Answer 7

Tallying cures. Studying clinical outcomes that imply absence of disease (BP, Cholesterol, Liver function, Anatomical changes)

Question 8

What are the key features of Biomedical Perspective?

Answer 8

Ties outcomes to “hard” sciences. Quantifiable measures (e.g. BP = mmHg). Objective measurement. Treats disease as binary (you have it or you don’t)

Question 9

What are the key limitations as central outcome for the Biomedical Perspective?

Answer 9

Weakly correlated with mortality and morbidity. Not as reliable as you would think. Create bad economic incentives. Definition of disease changes. Apples and oranges problem

Question 10

What is Epidemiological coding insensitive to?

Answer 10

Morbidity (which gets the same score as a health person = 1, while death gets 0)

Question 11

What type of model better demonstrates stages between healthy and death?

Answer 11

Outcomes model. Health = 1, morbidity = 0.2, death = 0

Question 12

Scale Types: What is Nominal?

Answer 12

Categories with no order (e.g. medical diagnoses)

Question 13

Scale Types: What is Ordinal?

Answer 13

Numeric assignments preserve order (e.g. Excellent = 5, Very good = 4, Good = 3, Fair = 2, and Poor = 1)

Question 14

Scale Types: What is Interval?

Answer 14

Numeric assignments preserve ratios of intervals. No true zero. Celsius = (5/9)(Fahrenheit - 32)

Question 15

Scale Types: What is Ratio?

Answer 15

Numeric assignments preserve ratios of values. True zero. Mass (kg), Length (m), Time (sec)

Question 16

Blood pressure (mmHg), or time to climb a flight of stairs (sec) are what types of scales of health?

Answer 16

Ordinal

Question 17

What is the Short Form 36 Health Survey (SF-36)?

Answer 17

Validated, widely used generic measure of HRQOL: 8 domains, scored 0-100, age, gender, adjusted norms. 2 summary scores: Physical component (PCS: Measures how decrements in physical function affect activity), Mental component (MCS: Measures affective and pain symptoms on HRQOL). Gives a profile of domain scores

Question 18

What are the Key Features of the SF-36?

Answer 18

Psychometric validation. Can compare across medial samples. Easy comparison to general population. Profile describes a health picture

Question 19

What are the Key Limitations of the SF-36?

Answer 19

Measure has an ordinal basis. Scores do not reflect preference for domain levels. No overall score. No variable for sleep. Lower response rate > 65 years

Question 20

What is the Quality of Well Being Scale?

Answer 20

Assesses patient’s objective level of functioning in three domains (Mobility, Physical activity, Social activity). Focus on “what you did” in the past 6 days. Assesses an array of symptoms. “SA” version is self-administered. Preference based (Item weight reflects preference for condition). Score between 0 (death) and 1 (full health). Sensitive to changes in disease state. Original QWB has the basis for SF-36 domains in RAND MOS

Question 21

What is the EQ-5D?

Answer 21

European quality of life 5 demensions. Five Dimensions: Mobility, Self care, Usual activities, Pain/Discomfort, Anxiety/Depression. Three levels: No problems, Some problems, Extreme problems